Contract Schedule-S40875-01
EX-4.BI 4 ex4bi.htm BASE CONTRACT SCHEDULE
| Contract Schedule | |||
| Owner: | [John Doe] | Contract Number: | [??687456] |
| Owner’s Date of Birth: | [January 15, 1977] | Issue Date: | [04/15/22] |
| Owner’s Gender: | [Male] | Maximum Issue Age: | [80] |
| [Joint Owner: | [Jane Doe]] | Annuitant: | [John Doe] |
| [Joint Owner’s Date of Birth: | [January 15, 1977]] | Annuitant’s Date of Birth: | [January 15, 1977] |
| [Joint Owner’s Gender: | [Female]] | Annuitant’s Gender: | [Male] |
| Determining Life (Lives): | [John Doe] | ||
| [Jane Doe] | |||
Purchase Payments
Interim Fund(s): [AZL Government Money Market Fund]
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, on a non-
discriminatory basis]
Variable Account: [Allianz Life Variable Account B]
Contract Charges
Product Fee: [1.25]%
Contract Maintenance Charge: $[50.00] each Contract Year 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 | 7.00% |
| 3 | 6.00% |
| 4 | 5.00% |
| 5 | 4.00% |
| 6 years or more | 0%] |
Annuity Payments
Maximum Annuity Date: [Index Anniversary on or after the day the Annuitant attains age 100]
Minimum Annuity Payment: $[100.00]
Annuity Mortality Table: [2012 Individual Annuity Reserve Table]
Minimum Annual Annuity Payment Rate: [1.00]%
| Contract Schedule continued from the previous page |
Guaranteed Purchase Rate Tables
The tables below are examples of Guaranteed Purchase Rates for a representative set of ages in certain calendar years. Guaranteed Purchase Rates are based on the Annuity Mortality Table and Minimum Annual Annuity Payment Rate shown in the Annuity Payments section of the Contract Schedule. Guaranteed Purchase Rates may vary by Age on Annuity Date, Annuity Option, and the calendar year in which Annuity Payments begin.
The Guaranteed Purchase Rates shown below in Tables 2, 3, and 4 are only applicable if Annuity Payments begin for the designated Age on Annuity Date in the designated calendar year.
Upon request, we will furnish rates for ages and guaranteed periods not shown. Guaranteed Purchase Rates may change based on the calendar year in which annuitization occurs.
| TABLE 1: GUARANTEED PERIOD | |
| Monthly installments per $1,000, payable for the guaranteed period | |
| Guaranteed | Monthly |
| Period | Installments |
| 10 | $[8.37] |
Guaranteed Purchase Rates for the Life, Life with a Guaranteed Period, Joint and Survivor, and Joint and 2/3 Survivor change based on the calendar year in which annuitization occurs.
| TABLE 2: LIFE | ||||||
| Monthly installments per $1,000 payable while the Annuitant is living | ||||||
| Guaranteed Rates for [2025] | Guaranteed Rates for [2035] | Guaranteed Rates for [2045] | ||||
| Age of Annuitant on Annuity Date | Male Annuitant | Female Annuitant | Male Annuitant | Female Annuitant | Male Annuitant | Female Annuitant |
| [60 | $[2.91 | 2.76 | 2.83 | 2.70 | 2.76 | 2.65 |
| 70 | 4.26 | 3.97 | 4.11 | 3.86 | 3.98 | 3.76 |
| 80] | 7.26 | 6.58 | 6.95 | 6.36 | 6.68 | 6.16] |
| LIFE WITH A GUARANTEED PERIOD - Male Annuitant | ||||||
| Monthly installments per $1,000, payable for the | ||||||
| guaranteed period and thereafter while the Annuitant is living | ||||||
| Guaranteed Rates for [2025] | Guaranteed Rates for [2035] | Guaranteed Rates for [2045] | ||||
| Age of Annuitant on Annuity Date | Guaranteed Period | Guaranteed Period | Guaranteed Period | |||
| 5 years | 10 years | 5 years | 10 years | 5 years | 10 years | |
| [60 | $[2.91 | 2.89 | 2.83 | 2.81 | 2.75 | 2.74 |
| 70 | 4.24 | 4.14 | 4.09 | 4.01 | 3.96 | 3.89 |
| 80] | 7.02 | 6.26 | 6.76 | 6.12 | 6.52 | 5.98] |
| Contract Schedule continued from the previous page |
| LIFE WITH A GUARANTEED PERIOD - Female Annuitant | ||||||
| Monthly installments per $1,000, payable for the | ||||||
| guaranteed period and thereafter while the Annuitant is living | ||||||
| Age of Annuitant on Annuity Date | Guaranteed Rates for [2025] | Guaranteed Rates for [2035] | Guaranteed Rates for [2045] | |||
| Guaranteed Period | Guaranteed Period | Guaranteed Period | ||||
| 5 years | 10 years | 5 years | 10 years | 5 years | 10 years | |
| [60 | $[2.76 | 2.75 | 2.70 | 2.69 | 2.64 | 2.63 |
| 70 | 3.95 | 3.88 | 3.84 | 3.78 | 3.75 | 3.70 |
| 80] | 6.42 | 5.87 | 6.23 | 5.75 | 6.05 | 5.64] |
| TABLE 3: JOINT AND SURVIVOR | |||||||||
| Monthly installments per $1,000, payable while either Annuitant is living | |||||||||
| Guaranteed Rates for [2025] | Guaranteed Rates for [2035] | Guaranteed Rates for [2045] | |||||||
| Age of Annuitant on Annuity Date | Age of Annuitant on Annuity Date | Age of Annuitant on Annuity Date | Age of Annuitant on Annuity Date | ||||||
| [60 | 70 | 80 | 60 | 70 | 80 | 60 | 70 | 80] | |
| [60 | $[2.35 | 2.60 | 2.72 | 2.31 | 2.56 | 2.66 | 2.28 | 2.51 | 2.61 |
| 70 | 2.60 | 3.25 | 3.73 | 2.56 | 3.18 | 3.64 | 2.51 | 3.12 | 3.55 |
| 80] | 2.72 | 3.73 | 5.09 | 2.66 | 3.64 | 4.96 | 2.61 | 3.55 | 4.84] |
| TABLE 4: JOINT AND 2/3 SURVIVOR | |||||||||
| Monthly installments per $1,000, payable while both Annuitants are living. After the death of one Annuitant, 2/3 of the original installment amount will continue while the surviving Annuitant is living | |||||||||
| Guaranteed Rates for [2025] | Guaranteed Rates for [2035] | Guaranteed Rates for [2045] | |||||||
| Age of Annuitant on Annuity Date | Age of Annuitant on Annuity Date | Age of Annuitant on Annuity Date | Age of Annuitant on Annuity Date | ||||||
| [60 | 70 | 80 | 60 | 70 | 80 | 60 | 70 | 80] | |
| [60 | $[2.61 | 3.01 | 3.40 | 2.56 | 2.94 | 3.32 | 2.51 | 2.88 | 3.25 |
| 70 | 3.01 | 3.70 | 4.46 | 2.94 | 3.60 | 4.34 | 2.88 | 3.52 | 4.23 |
| 80] | 3.40 | 4.46 | 5.99 | 3.32 | 4.34 | 5.81 | 3.25 | 4.23 | 5.65] |
