Annuity Contract Schedule between Allianz Life of New York and John Doe (with Jane Doe as Joint Owner)

Summary

This contract schedule outlines the terms for an annuity agreement between Allianz Life of New York and John Doe, with Jane Doe as a possible joint owner. It specifies purchase payment requirements, transfer limits, contract charges, withdrawal rules, and annuity payment options. The contract includes details on minimum and maximum payments, fees, withdrawal penalties, and available investment options. The annuity is set to begin on April 1, 2065, and includes various guaranteed payment options based on age and selected riders. Key conditions and rates are clearly defined for the contract's duration.

EX-4.B 3 d687696dex4b.htm EX-4.B EX-4.b

EX-99.4.b. Schedule Pages

Contract Schedule


Owner:	[John Doe]	Contract Number:	[??687456]
[Joint Owner:	[Jane Doe]]	Issue Date:	[04/15/10]
Annuitant:	[John Doe]	Scheduled Annuity Date:	[04/01/65]
Determining Life (Lives):	[John Doe]	Maximum Issue Age:	[80]
	[Jane Doe]

Purchase Payments


Initial Purchase Payment:		$[10,000.00]
Minimum Additional Purchase Payment:		$[50.00]
Maximum Total Purchase Payments:		$1 million; higher amounts may be accepted with our approval

Transfers


Number of Free Transfers Permitted:		[12] each Contract Year
Transfer Fee:		$25.00 for each transfer in excess of the free transfers permitted
Transfer Index Anniversary:		Every [Sixth] Index Anniversary

Contract Charges


Product Fee:		[1.25]%
Contract Maintenance Charge:		$[50.00] each Contract Year
Designated Amount:		Contract Value must be $[100,000.00] to waive the Contract Maintenance Charge

Withdrawals


Minimum Partial Withdrawal:		$[100.00]
Minimum Required Value:		$[2,000.00]
Free Withdrawal Amount:		[10]% of total Purchase Payments

Withdrawal Charge Percentages Table


Number of Complete Years Since Receipt of Purchase Payment	Charge
0		8.5	%
1		8	%
2		7	%
3		6	%
4		5	%
5		4	%
6 years or more		0	%

Annuity Payments


Minimum Annuity Payment:		$[100.00]
Annuity Mortality Table:		[Annuity 2000 Mortality Table]
Minimum Annual Annuity Payment Rate:		[1.00]%

Riders:

[The applicable riders based on the information from the application will populate this area.]

Guaranteed Purchase Rate Table

Upon request, we will furnish rates for ages and guaranteed periods not shown.

Annuity Options—Guaranteed monthly annuity payments per $1,000


	Option 1				Option 2								Option 3		Option 4		Option 5
					10-year guaranteed period				20-year guaranteed period				100% joint and survivor		10-year guaranteed period
Age on Annuity Date	Male		Female		Male		Female		Male		Female		Male & Female Same Age		Male & Female Same Age		Male		Female
30		[2.08		1.97		2.08		1.97		2.07		1.97		1.84		1.84		2.00		1.92
40		2.45		2.29		2.45		2.29		2.42		2.28		2.10		2.10		2.29		2.19
50		3.02		2.78		3.00		2.77		2.92		2.73		2.49		2.49		2.70		2.57
60		3.95		3.57		3.87		3.53		3.59		3.37		3.12		3.11		3.29		3.14
70		5.66		5.03		5.28		4.83		4.24		4.13		4.22		4.20		4.18		4.00
80		8.93		8.09		7.07		6.79		4.55		4.53		6.37		6.04		5.54		5.38
90		15.24		14.64		8.36		8.30		4.59		4.59		10.68		7.98		7.66		7.50	]

[3A]

Variable Options Contract Schedule


Owner:	[John Doe]	Contract Number:	[??687456]
[Joint Owner:	[Jane Doe]]	Issue Date:	[04/15/10]
Annuitant:	[John Doe]	Scheduled Annuity Date:	[04/15/65]

Allocation Guidelines:

1. [Currently, you can select up to [3] of the Variable Options. This number will not decrease after the Issue Date.]

2. Allocations must be made in whole percentages.

Variable Options:

Variable Account: [Allianz Life of New York Variable Account C]

[AZL Money Market Fund

AZL MVP Balanced Index Strategy Fund

AZL MVP Growth Index Strategy Fund]