Required…

                                                             Required Minimum Distributions
                                                             (RMD) Request Instructions


Important Notes:
· If this form is incomplete or not legible when returned, your request may be delayed.
· Once a payout/withdrawal has occurred it cannot be reversed.
· 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/Owner.
·   Enter the Social Security number of the Annuitant/Owner.
·   Enter the annuity contract number(s).
·   Enter the address and phone number of the owner.
Required Minimum Distribution Information
·   Check the box to designate the RMD distribution frequency (annuities must be annual).
·   Enter the RMD payout date (1-28).
·   If your spouse is 10 years younger, please enter their date of birth.
·   Check the box if you wish to delay or suspend your RMD distribution.
     · If you delay or suspend your RMD distributions, you are responsible for ensuring that your RMD is met elsewhere.
Method of Distribution
· Check the box to designate the distribution method: Check or Direct Deposit.
· 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 checks.
     This number begins with a 0, 1, 2 or 3.




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 you want your RMD to be applied to another contract, form 10438 should be used each year since this can not be
  completed automatically through the RMD option.
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.




14643INS    R1-07
Notification for Federal and State Income Tax Withholdings
· 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.
· Certain states require that your federal withholding election must follow what your state tax election is (e.g. if you want
  a percent/dollar for state tax, then you must also elect federal tax, if you do not want state tax you must also say no to
  federal tax 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 complete this request.
· Types of required signatures:
  · 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
  · 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)




14643INS   R1-07