…

                                                                         Partial or Complete
                                                                         Withdrawal Instructions


Important Notes:
· If this form is incomplete or not legible when returned, your request may be delayed.
· Once this transaction has been processed it cannot be reversed.
· Only one contract per form.
· Questions on completing this form may be directed to the Thrivent Financial Customer Interaction Center at
  800-847-4836, Monday ­ Friday 7am­9pm CST, or Saturday 9am­1pm CST.
· Send completed forms to: PO Box 8075, Appleton WI, 54912-9722 or fax them to 800-225-2264. For your own
  security, do not e-mail the completed forms to Thrivent, as e-mailed forms will not be accepted.

General Information
·   Enter the name of the Annuitant.
·   Enter the Social Security Number of the Annuitant.
·   Enter the annuity contract number.
    · If your annuity contract is a Tax Sheltered Annuity (TSA/403(b), Money Purchase, or Profit Share Plan,
      please contact the Customer Interaction Center because additional forms are required.
·   Enter the address and phone number of the owner.
Distribution Type
·   Check the box to designate a Complete or Partial Withdrawal.
    · Enter the amount or percentage if you are requesting a partial withdrawal.
    · If the amount is over $100,000, see Medallion Signature Guarantee or Notary Public requirement later on this
      instruction document and on the form.
·   Check the box to add or subtract withdrawal charges and tax withholding. (Add charges/withholding results in a net
    distribution, subtracting charges/withholding results in a gross distribution).
·   Enter subaccount designations for variable annuity withdrawals only, if nothing is indicated, the withdrawal will
    process proportionately from each subaccount.
Distribution Option Desired
· Check the box to designate the distribution method: Check, Direct Deposit, or Apply proceeds to another contract.
· If you are requesting Direct Deposit:
   · Fill in your bank account number, indicate checking or savings, or include a copy of a voided check.
   · For checking, the Transit number is the 9 digit routing number located on the bottom of left corner of your check.
      This number begins with a 0, 1, 2 or 3.




· If you are requesting to apply proceeds to another contract/policy:
   · Check the box titled "Apply proceeds of $".
   · Enter the contract number(s) receiving the funds.
   · Enter the premium or loan amount that should be applied to the receiving contract.




10438INS    R1-07                                               1
Note:
· If funds are being sent to a bank account other than the contract owner, if a check is made payable to someone other
  than the contact owner, or a check is sent to an address other than the address of record a Medallion Signature
  Guarantee for variable annuities or a Notary Public for fixed annuities is required, see below for additional information.
· If your intent is to complete an IRA transfer or Rollover to an IRA, other Company Paperwork is required.
Taxable Gain ­ This must be completed.
· IRA = all taxable
· ROTH = undetermined
· Non-Pension = all or a portion of your distribution may be taxable. Note: Two or more non-pension contracts issued in
  the same calendar year may increase your taxable gain. Contact the Customer Interaction Center for assistance.
Penalty Tax
· If you are under age 59 ½, the IRS may assess a 10% premature distribution penalty on the taxable portion of your
  withdrawal.
Withdrawal Charges ­ Must be completed.
· Withdrawal charges may apply based on the issue date of your contract and/or the amount of your withdrawal request.
  Note: A withdrawal of 10% of your cash value can be withdrawn each contract year without a charge. Contact the
  Customer Interaction Center for assistance.
Request for Waiver of Surrender Charges
· If confinement to a nursing home or assisted living facility applies and is not already on file at Thrivent, form 14804
  (available at Thrivent.com) is also required.
Triggering Event
· Enter the triggering event for TSA/403(b) annuities only.
· If your annuity contract is a Tax Sheltered Annuity (TSA/403(b)), Money Purchase, or Profit Share Plan, please
  contact the Customer Interaction Center because additional forms are required.
Notification for Federal and State Income Tax Withholdings
· If there is a taxable event, your request will be subject to Federal and State Income Tax Withholding. If no box is
  checked, Thrivent will automatically withhold 10% federal and any required state income tax withholding.
· Note: A ROTH IRA distribution does not allow for any withholding.
· North Carolina requires NC-4P form for no withholding, available at Thrivent.com or www.state.nc.us.
Medallion Signature Guarantee or Notary Public Stamp
· A Medallion Signature Guarantee is required for Variable Annuities, and a Notary Public is required for Fixed Annuities
  in these situations:
  · Withdrawal amount exceeds $100,000 (net).
  · Send proceeds by check to an address other than the address on file at Thrivent Financial.
  · Make the proceeds payable to someone other than the current owner(s).
Signatures
· Signature from the owner(s) is required to process each withdrawal.
· Types of required signatures:
  · Absolutely assigned to a corporation, church, or partnership
    · Signatures of two officers and their titles
  · Collaterally assigned
    · Signature of one officer and his/her title, and the signature of the contract owner
  · Owned by a trust
    · Signatures of all trustees with the titles of their legal capacities (trustee)
    · Copy of the pages of the Trust that indicate the name of the Trust, date of the Trust, and the names of the Trustees
      and Successor Trustees
    · The Certification of Trust, form 24143, available at Thrivent.com
  · POA, guardian or conservator
    · Signature of the POA, guardian, or conservator along with the title of legal capacity in which they are acting
    · Copy of the legal documents supporting this capacity



10438INS     R1-07                                                2
  · Contract has an irrevocable beneficiary
    · Signature of the irrevocable beneficiary (and title if applicable)
    · If funeral establishment is the beneficiary, authorization on their letterhead is required, and a copy of the pre-needs
      agreement
    · Signature of the owner(s)
  · Joint Owners
    · Signatures of all owners




10438INS    R1-07                                                3