Allianz Life Insurance Company of New York Annuity Contract Schedule for John Doe and Jane Doe
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Summary
This contract schedule outlines the terms for an annuity agreement between Allianz Life Insurance Company of New York and the owner, John Doe, with Jane Doe as the annuitant. It details purchase payment requirements, withdrawal rules, transfer limits, contract charges, and annuity payment options. The agreement specifies allocation options among various investment strategies and indices, as well as associated fees and conditions. The contract also includes important information about trademark licenses for referenced financial indices. Key obligations include maintaining minimum values, adhering to payment schedules, and following allocation guidelines.
EX-4.B 5 4b.htm SCHEDULE PAGES
| Contract Schedule | |||
| Owner: | [John Doe] | Contract Number: | [??687456] |
| [Joint Owner: Annuitant: | [Jane Doe]] [John Doe] | Issue Date: Scheduled Annuity Date: | [04/15/10] [04/01/65] |
| Annuitant's Age | Maximum Issue Age: | [80] | |
| and Gender: | [35 Male] | ||
Determining Life (Lives): [John Doe]
[Jane Doe]
Purchase Payments
Initial Purchase Payment: $[10,000.00] Minimum Additional Purchase Payment: $[50.00] Maximum Total Purchase Payments: $1 million
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
Mortality and Expense Risk Charge: [1.25]% of the Variable Options' net asset value Contract Maintenance Charge: $[50.00] each Contract Year
| Entire Contract Value: | Equals the sum of the Contract Value of each [Index Advantage NF New York] contract |
Contract Maintenance Charge Waiver Minimum: $[100,000.00]
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 | 8.50% |
| 1 | 8.00% |
| 2 | 6.50% |
| 3 | 5.00% |
| 4 | 3.00% |
| 5 | 1.00% |
| 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]%
Allowed Payees: [Financial institution, qualified plan, court-ordered individual]
Guaranteed Purchase Rate Table
Upon request, we will furnish rates for ages and guaranteed periods not shown.
Contract Schedule continued from the previous page
| Annuity Options - Guaranteed monthly annuity payments per $1,000 | ||||||||||
| Option 1 | Option 2 | Option 3 | Option 4 | Option 5 | ||||||
| Life Annuity | Life with 10-year guaranteed period | Life with 20-year guaranteed period | 100% joint and survivor | 100% joint and survivorwith10- year guaranteed period | Refund Life Annuity | |||||
| Age of Annuitant 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] |
| S40875-NF-NY |
| [3A] |
EX-99.B4.f
Allocation Options Contract Schedule
| Owner: | [John Doe] | Contract Number: | [??687456] |
| [Joint Owner: Annuitant: | [Jane Doe]] [John Doe] | Issue Date: Scheduled Annuity Date: | [04/15/10] [04/15/65] |
| Annuitant's Age | [35 Male] | ||
| and Gender |
Allocation Guidelines:
| 1. | [Currently, you can select up to [3] of the Variable Options. This number will not decrease after the Issue Date. |
| 2. | Currently, you can select up to [4] of the Index Performance Strategy Index Options. This number will not decrease after the Issue Date. |
| 3. | Currently, you can select up to [4] of the Index Protection NY Strategy Index Options. This number will not decrease after the Issue Date. |
| 4. | Currently, you can select up to[4] of the Index Precision Strategy Index Options. This number will not decrease after the Issue Date. |
5.] Allocations must be made in whole percentages.
Variable Options:
Variable Account: [Allianz Life® of NY Variable Account C]
[AZL® Money Market Fund
AZL® MVP Balanced Index Strategy Fund AZL® MVP Growth Index Strategy Fund]
Index Options:
Index Account: [Separate Account IANY]
Index Performance Strategy Index Options
| Index | Buffer for all Index Years | Minimum Cap for all Index Years |
| [S&P 500® Index | [10.00]% | [0.10]%] |
| [Nasdaq-100® Index | [10.00]% | [0.10]%] |
| [Russell 2000® Index | [10.00]% | [0.10]%] |
| [EURO STOXX 50® | [10.00]% | [0.10]%] |
Index Protection NY Strategy Index Options
| Index | Buffer for all Index Years | Minimum Cap for all Index Years |
| [S&P 500® Index | [30.00]% | [0.10]%] |
| [Nasdaq-100® Index | [30.00]% | [0.10]%] |
| [Russell 2000® Index | [30.00]% | [0.10]%] |
| [EURO STOXX 50® | [30.00]% | [0.10]%] |
Allocation Options Contract Schedule continued from the previous page
Index Precision Strategy Index Options
| Index | Buffer for all Index Years | Minimum Precision Rate for all Index Years |
| [S&P 500® Index | [10.00]% | [0.10]%] |
| [Nasdaq-100® Index | [10.00]% | [0.10]%] |
| [Russell 2000® Index | [10.00]% | [0.10]%] |
| [EURO STOXX 50® | [10.00]% | [0.10]%] |
The terms of the license agreements between us and [S&P Dow Jones Indices LLC, Russell Investments, NASDAQOMX Group Inc. and STOXX Limited] for the Indices require us to state the following:
[S&P® is a registered trademark of Standard& Poor's Financial Services LLC ("S&P"). This trademark has been licensed for use by S&P Dow Jones Indices LLC and its affiliates. S&P® and S&P 500® are trademarks of S&P. These trademarks have been sublicensed for certain purposes by Allianz Life Insurance Company of New York ("Allianz Life of NY"). The S&P 500 is a product of S&P Dow Jones
Indices LLC and/or its affiliates and has been licensed for use by Allianz Life of NY. Allianz Life of NY products are not sponsored, endorsed, sold, or promoted by S&P Dow Jones Indices LLC, Dow Jones, S&P, or their respective affiliates and neither S&P Dow Jones Indices LLC, Dow Jones, S&P, or their respective affiliates make any representation regarding the advisability of investing in such product.]
[The NASDAQ-100 Index® includes 100 of the largest domestic and international non-financial securities listed on The NASDAQ Stock Market, based on capitalization. The NASDAQ-100®, NASDAQ-100 Index®, NASDAQ®, and OMX® are registered trademarks of
NASDAQ OMX Group, Inc. (which with its affiliates are the Corporations)and are licensed for use by Allianz Life Insurance Company of New York. The product(s) have not been passed on by the Corporations as to their legality or suitability. The product(s) are not issued, endorsed, sold, or promoted by the Corporations. THE CORPORATIONS MAKE NO WARRANTIES AND BEAR NOLIABILITY WITH RESPECT TO THE PRODUCT(S).]
[The Russell2000® is a trademark of Russell Investments and has been licensed for use by Allianz Life Insurance Company of New York. Allianz products are not sponsored, endorsed, sold or promoted by Russell Investments and Russell Investments makes no representation regarding the advisability of investing in Allianz products.]
[The EURO STOXX 50® is the intellectual property(including registered trademarks) of STOXX Limited, Zurich, Switzerland. The product based on the Index is in no way sponsored, endorsed, sold or promoted by STOXX and shall not have any liability with respect thereto.]
