28887 Page 2 of 2 R3-21
Miscellaneous Provisions
Charity as Beneficiary: Thrivent may have the contractual right to prohibit annuitization elected by a charity at time of claim.
Final Services Funding: Thrivent may accept designations to name an entity which will provide for reimbursement to a
state recovery program for services or for final services. An example of a state recovery program is Medicaid Estate
Recovery. Examples of final services include, but are not limited to, funeral, mortuary, cemetery, cremation, and funeral
trust. Any state recovery program or final services entity is permitted to receive only those proceeds necessary to
reimburse for services received by the insured or pay the insured's final expenses. Verification of final expenses or
reimbursement is required prior to payment of any claim. The balance of any proceeds shall be paid according to the
beneficiaries you name. If there are no named beneficiaries, then the balance of any proceeds shall be paid to the
insured's estate.
Irrevocable Beneficiary: To designate a primary or contingent beneficiary as irrevocable, indicate "irrevocable" in the
beneficiary designation. After an irrevocable beneficiary is named any changes to the contract can only be made with the
consent of the irrevocable beneficiary. These changes include beneficiary changes, loans, withdrawals, contract
surrender,dividend option changes, and long-term care claim payments for Care Forward contracts
Minor Beneficiaries
When Naming a Custodian: You may wish to direct payment of proceeds to minor beneficiaries by naming a custodian.
You may designate: a custodian who will control property until it is transferred to the beneficiary. These designations will
be administered under the Uniform Transfers to Minors Act (or similar law) of the state where the minor resides unless
another state is designated.
When Not Naming a Custodian: If any proceeds are payable to a person under age 18 at the time of claim and you did
not designate a custodian, you are deemed to elect to use the state where the minor resides on the date of the insured's
death to administer the property under the Uniform Transfers to Minors Act (or similar state law). Thrivent may pay, as
custodian, any adult family member with whom the client resides.
Simultaneous Death
A beneficiary will be treated as having predeceased the insured if: 1) that beneficiary dies at the same time as the
insured; or 2) within 15 days of the insured.
This provision shall not apply if the proceeds have already been paid to the beneficiary.
Your contract may contain a 15 day survival provision. If your contract contains this provision, that provision will control.
Group Designations
Thrivent strongly encourages individuals to be named, as this can clarify your intent with regards to beneficiary
designations.
Thrivent will only approve the following Group Designations: 1) children; 2) sons; 3) daughters; 4) brothers; 5) sisters; 6)
half-brothers; 7) half-sisters; 8) grandchildren; 9) great-grandchildren; 10) granddaughters; and 11) grandsons.
Unless you specify otherwise, group designations shall only include naturally born or legally adopted members of that
group. For example, step-children who you have not legally adopted will not be included in a group designation of Children.
Per Stirpes
Per Stirpes is a stipulation directing that proceeds pass to the children of a beneficiary if that beneficiary pre-deceases
the insured. If none survive the insured, proceeds will pass according to the instructions outlined in the Beneficiary
Shares provision.
This stipulation may be added to any group or individual with approval from Thrivent. All provisions outlined under Group
Designations will also apply to a Per Stirpes stipulation.
Signature - A signature is only required for new business applications in the state of New York.
By signing this form, I certify that I have read and agree to all the provisions on this form.
Signature of owner/controller and date signed
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