Forms
Download forms and access online applications. Where available, links to online processes have been included. Note: If you are having trouble viewing one of the forms below, check the system requirements
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Annuities
403(b) & Qualified Plan Distribution Disclosure
9972 - This disclosure must be reviewed prior to submitting a distribution/redemption request for a 403(b). A signature confirming this review is required on the distribution/redemption request.
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Annuity/Settlement Option Surrender Service Request
10438 - Used to request a complete/partial surrender or establish/change an Automatic Payout Option from a deferred/immediate annuity or settlement option.
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Business Entity Information - Annuity & Insurance
23438 - Determine the authorized signer(s) and beneficial owners for Thrivent accounts/contracts owned by business entities.
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Distribution – Annuity
Partial withdrawals can be completed after logging into your account for most products. For assistance with partial or complete withdrawals, call 800-847-4836.
Submit online
Qualified Charitable Distribution Request
29998 - Complete this form to request a Qualified Charitable Distribution from an annuity or a Thrivent Funds account.
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Required Minimum Distribution Request for Ongoing Scheduled Payments
14643 - Establish the Required Minimum Distribution payout or make changes on an existing required minimum distribution payout.
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Rollover to Thrivent Annuities
11502 - Process internal and external transfers, direct rollovers and internal conversion of retirement plan accounts with Thrivent annuities.
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State Withholding for Annuity Payments
20017 - Use form 20017 to elect, change or opt out of state withholding for your settlement options and immediate annuity payouts.
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Subaccount Transfer Selection
15773 - Use to transfer accumulated value among the subaccount and fixed account, subject to certain limitations.
VA20 RETIREMENT CHOICE ONLY. Use to transfer accumulated value among the subaccount and fixed account, subject to certain limitations. DO NOT USE WITH GLWB.
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VA20 RETIREMENT CHOICE ONLY. Use to transfer accumulated value among the subaccount and fixed account, subject to certain limitations. DO NOT USE WITH GLWB.
Subaccount Transfer Selection – AdvisorFlex VA only
15773AF - One-time, periodic transfer of funds between subaccounts on any of your AdvisorFlex variable products. Be sure to fill out this form accurately and completely or your request may be delayed.
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Withholding Certificate for Pension or Annuity Payments
W-4P - Use Form W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s).
Download W-4P
Withholding Certificate for Pension or Annuity Payments (in CT)
CT-W4P - Residents of Connecticut, use Form CT W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s).
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Beneficiary change
Beneficiary Change – Mutual Funds
MF307 - Complete this form to designate or update your beneficiary election on a Thrivent Funds retirement account.
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Beneficiary Provisions
28887 - Provides disclosure information for designating eligible beneficiaries. Provide provisions form 28887 to owner(s). Life, health and annuity applications in the state of New York must include a signed 28887.
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Billing & payments
403(b) Contribution Agreement
5245 - Request to remit 403(b) contributions for purchase of an annuity contract or mutual fund shares.
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Bank Change – Direct Payment – Annuity & Insurance
6568 - Withdrawals are prepared each month on the withdrawal date you select (1-28) and are routed through the Federal Reserve System to the account owner's financial institution. One withdrawal is produced for each Thrivent Direct Payment account, and for each withdrawal date selected. Withdrawals returned unhonored due to insufficient funds will automatically be presented a second time to the account owner's financial institution for payment.
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Bank Change – Direct Payment – Thrivent Funds
MF6568 - Complete this form to establish, update or stop automatic withdrawals from a bank account to a Thrivent Funds account.
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Variable Products Allocation Change/Remittance Request
V6406 - Make permanent changes to your premium allocation for future payments or make a one-time change with a payment on any of your variable products.
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Complaint
Request for Arbitration
15253 - Submit a formal request for Arbitration. (After completing the Complaint, MDRP Appeal, MDRP Mediation processes.)
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Request for Mediation
26909 - Submit a formal request for Mediation. (After completing the Complaint and MDRP Appeal processes.)
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Death claim
Beneficiary Statement (All Options)
28E - Used by a beneficiary to indicate how they would like to receive their portion of a claim. This form includes distribution options. To determine if this form is needed, call 920-628-6312 or contact your financial advisor for assistance.
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Beneficiary Statement (Check or Direct Deposit Only)
28E CASH - Used by a beneficiary to indicate they would like to receive their portion of a claim via check or direct deposit. All other elections use the Beneficiary Statement (form 28E). To determine if this form is needed, call 920-628-6312 or contact your financial advisor for assistance.
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Deceased Beneficiary's Children Affidavit
5909A - Used when the beneficiary designation has a 'per stirpes' designation and a named or unnamed beneficiary is predeceased. This form defines who are the children are (sometimes referred to as 'issue') of a predeceased beneficiary with the per stirpes designation, for distribution of proceeds of that predeceased beneficiary's portion. To determine if this form is needed, call 920-628-6312 or contact your financial advisor for assistance.
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Surviving Beneficiary Affidavit
5909 - Used to identify the person(s) in a beneficiary class designation such as children, born or adopted (stepchildren are not included), grandchildren, brothers/sisters, or others such as nieces or nephews named as beneficiary on a contract. Example: Beneficiary designation is 'Children, per stirpes'. To determine if this form is needed, call 920-628-6312 or contact your financial advisor for assistance.
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Disability income insurance
Claims – Disability Insurance (in all states except NY)
DI259 - File a claim under your disability income contract. Complete it immediately upon disability. If claiming benefits under both a disability income and life contract, it is not necessary to complete a separate form for each benefit. Do not use this form if you live in NY. Instead see Claims – Disability Insurance (if you live in NY), below.
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Claims – Disability Insurance (if you live in NY)
DI259NY - File a claim under your disability income contract. Complete it immediately upon disability. If claiming benefits under both a disability income and life contract, it is not necessary to complete a separate form for each benefit. Use this form only if you live in NY.
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Health Surrender Request
31294 - Use this form to surrender a Disability Income, Legacy Long-Term Care, or Medicare Supplement contract. Do not use this for CareForward, LTC U contracts or Medicare Supplement beginning with 1422.
Hospital confinement
Family hospital
Requirements
No claim forms are required. Send a copy of your itemized hospital bill or the UB04. Include the diagnosis if not on the bill or UB04.
Life insurance
Distribution – Life Insurance
Call 800-847-4836 or contact your financial advisor for assistance.
Life Premium Waiver/Disability Waiver Claim for Adults (in all states except NY)
LF259 - File a waiver claim on a life contract. Complete it after four/six (per the contract) consecutive months of total disability. Do not use this form if your only claim is for disability income or both life waiver and disability income. Instead, complete the Disability Income Insurance Claim (DI259).
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Life Premium Waiver/Disability Waiver Claim for Adults (in NY)
LF259NY - File a waiver claim on a life contract. Complete it after four/six (per the contract) consecutive months of total disability. Do not use this form if your only claim is for disability income or both life waiver and disability income. Instead, complete the Disability Income Insurance Claim (DI259).
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Life Premium Waiver/Disability Waiver Claim for Children (in all states except NY)
259C - File a child's waiver claim on a life contract. Complete it after four/six (per the contract) consecutive months of total disability. Total disability exists when a child is at least age five and, due to accidental bodily injury or disease, is unable to attend a regular school or a special education facility. Under some contracts the disability must begin after age five. Refer to the contract for specific requirements.
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Life Premium Waiver/Disability Waiver Claim for Children (in NY)
259NY - File a child's waiver claim on a life contract. Complete it after four/six (per the contract) consecutive months of total disability. Total disability exists when a child is at least age five and, due to accidental bodily injury or disease, is unable to attend a regular school or a special education facility. Under some contracts the disability must begin after age five. Refer to the contract for specific requirements.
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Third Party Notification for Nonpayment of Premium (in all states except CT, ME and NJ)
11600 - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
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Third Party Notification for Nonpayment of Premium (in CT)
11600CT - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
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Third Party Notification for Nonpayment of Premium (in ME)
11600ME - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
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Third Party Notification for Nonpayment of Premium (in NJ)
11600NJ - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
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Long-term care insurance
Claims – Long-Term Care (in all states except NY)
23057 - File a claim for long-term care benefits. File an LTC claim easily over the phone by calling 800-847-4836. Say "directory" and enter extension 628-3166 to work with a claim coordinator. No forms required.
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Claims – Long-Term Care (in NY)
23057NY - File a claim for long-term care benefits. File an LTC claim easily over the phone by calling 800-847-4836. Say "directory" and enter extension 628-3166 to work with a claim coordinator. No forms required.
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Health Surrender Request
31294 - Use this form to surrender a Disability Income, Legacy Long-Term Care, or Medicare Supplement contract. Do not use this for CareForward, LTC U contracts or Medicare Supplement beginning with 1422.
Third Party Notification for Nonpayment of Premium (in all states except CT, ME and NJ)
11600 - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
Download
Third Party Notification for Nonpayment of Premium (in CT)
11600CT - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
Download
Third Party Notification for Nonpayment of Premium (in ME)
11600ME - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
Download
Third Party Notification for Nonpayment of Premium (in NJ)
11600NJ - Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.
Download
Medicare supplement insurance
Requirements
No claim forms are required. Most claims are filed electronically through the Medicare carrier. For claims not filed electronically, send the original Explanation of Medicare Benefits (EOMB) and the itemized bill.
Mutual funds
403(b) Transfer/Exchange Request
MF24965 - Complete this form to request transfer, exchange, rollover or conversion into or out of a Thrivent Mutual Funds 403(b) account.
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403(b) & Qualified Plan Distribution Disclosure
9972 - This disclosure must be reviewed prior to submitting a distribution/redemption request for a 403(b). A signature confirming this review is required on the distribution/redemption request.
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Automated Payment of a Thrivent Product
9368C - Complete this form if you want to establish a systematic payout from a Thrivent Mutual Fund to pay the premium or loan repayment of another Thrivent product via the internal Electronic Payment System.
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Automatic Exchange Plan
MF23428 - Complete this form to establish ongoing systematic exchanges between funds within the same registration type and owner(s).
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Automatic Redemption Plan
MF23430 - Complete this form to establish ongoing systematic redemptions from a Thrivent Mutual Funds account.
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Bank Change – Direct Payment – Thrivent Funds
MF6568 - Complete this form to establish, update or stop automatic withdrawals from a bank account to a Thrivent Funds account.
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Beneficiary Change – Mutual Funds
MF307 - Complete this form to designate or update your beneficiary election on a Thrivent Funds retirement account.
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Business Entity Information - Mutual Funds
MF23438 - Complete this form to provide authorized signers and beneficial owners for business entities on a Thrivent Funds account.
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Certification of Trust – Mutual Funds
24143A - Complete this form to provide information about a trust in a Thrivent Funds account.
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Dividends/Capital Gains Distribution
MF23429 - Complete this form to establish or update dividend/capital gain distribution or reinvestment options on a Thrivent Funds account.
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Employer/Employee Contribution Correction Request
MF24385 - Complete this form for employer or employee error corrections on contributions for a Thrivent Funds SEP, SIMPLE or 403(b) account/Tax Sheltered Annuity.
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Establish Telephone Transactions
MF23435 - Complete this form to establish, change or stop telephone redemption, exchange or purchase options on a Thrivent Funds account.
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Excess Removal of SIMPLE IRA Employee Contributions
MF24999 - Complete this form to remove excess employee contributions from a Thrivent Funds SIMPLE IRA account.
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Excess Removal From Traditional IRA/Roth IRA/SEP IRA/SARSEP IRA
6535 (no "MF") - Complete this form to remove excess contributions from a Traditional IRA, Roth IRA, SEP IRA or SARSEP IRA Thrivent Funds account.
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Exchange Request
MF23434 - Complete this form to exchange between accounts in Thrivent Mutual Funds with the same registration type and owner(s).
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Mutual Funds Interested Party Statement Authorization
MF26822 - Complete this form to add an interested party to your Thrivent Funds account to have statements sent to a third party.
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Nonqualified Account Transfer Request
MF10136 - Complete this form to initiate a redemption or transfer in kind from another company.
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Non-Retirement Account Beneficiary Claim – Mutual Funds
MF34914 - Complete this form to move dollars inherited by the passing of the account owner to the beneficiary from a non-retirement account. Dollars can be moved to an account for the beneficiary or redeemed.
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Non-Retirement Account Distribution – Mutual Funds
MF23433 - Complete this form to redeem dollars from a personal or business Thrivent Mutual Funds account.
Submit online
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Plan Administration Online Access
MF29612 - Complete this form to request access to Plan Administration Online which will allow group plan administrators (SIMPLE, SEP, 403(b)) to submit payments electronically and manage participant rosters for their Thrivent Mutual Funds sponsored plans.
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Qualified Charitable Distribution Request
29998 - Complete this form to request a Qualified Charitable Distribution from an annuity or a Thrivent Funds account.
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Required Minimum Distribution Request
MF14643 - Complete this form to establish required minimum distributions on a retirement account type or qualified plan in Thrivent Mutual Funds.
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Download form W4-R to request withholding other than 0% or 10%
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Download form W4-R to request withholding other than 0% or 10%
Retirement Account Distribution
MF28938 - Complete this form to redeem dollars from a Thrivent Mutual Funds retirement account.
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Thrivent Funds Express Beneficiary Distribution
MF31399 - Complete this form to distribute all shares inherited by the passing of the account owner to the primary beneficiary of an individual, joint tenant, IRA, Roth IRA, SEP IRA or SIMPLE IRA account.
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Thrivent Funds Inherited IRA/Roth IRA Funding Request
Complete this form to elect distribution options available to the Thrivent Funds beneficiary on retirement plan assets they inherit.
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Thrivent Funds Request to Establish Cost Basis
26963 - Complete this form to update the cost basis election for covered shares on a Thrivent Mutual Funds account.
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Transfer of Ownership Suitability
26872 - Complete this form to provide suitability information when transferring ownership of a variable contract or mutual fund.
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Transfer/Rollover to Thrivent Funds
MF11502 - Complete this form to process internal and external transfers, direct rollovers and internal conversion of retirement plan accounts for Thrivent Funds.
For accounts opened and managed onThriventFunds.com, you may use our online process. Log in to ThriventFunds.com and add rollover to existing IRA accounts, or open a new account.
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Download form W4-R to request withholding other than 0% or 10%
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For accounts opened and managed on
Download form W4-R to request withholding other than 0% or 10%
Variable universal life insurance
Subaccount Transfer Selection
15773 - One-time, periodic transfer of funds between subaccounts on any of your variable products. Be sure to fill out this form accurately and completely or your request may be delayed.
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Subaccount Transfer Selection – AdvisorFlex VA only
15773AF - One-time, periodic transfer of funds between subaccounts on any of your AdvisorFlex variable products. Be sure to fill out this form accurately and completely or your request may be delayed.
Download
Connect with a financial advisor
Call our Virtual Advice Team
Phone 888-834-7434
M–F, 8 a.m. to 6 p.m. CT
The Virtual Advice Team is a team of licensed financial advisors and professionals available to assist you during designated business hours. Our team offers a full variety of products and services. If you prefer to meet with a local financial advisor or professional, our team can connect you with someone in your area. Whether you work with the Virtual Advice Team, or with a local Thrivent financial advisor or professional, there will generally be no difference in the fees and expenses you will incur.
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