Charge

EX-4.B 5 ex4b.htm SCHEDULE PAGES

 
Contract Schedule

Owner: [John Doe] Contract Number: [??687456]
[Joint Owner: [Jane Doe]] Issue Date: [04/15/10]
Annuitant: [John Doe]
Annuitant's Age
and Gender: [35 Male] 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
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] 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
7.00%
           
3
6.00%
           
4
5.00%
           
5
4.00%
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]%

S40875-NF [3]
 

Contract Schedule continued from the previous page

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 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 [3A]
 
 

Index 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]
Annuitant's Age [35 Male]
and Gender

Alternate Minimum Value
AMV Factor [87.50]%
AMB Factor [87.50]%
Alternate Interest Rate [1.00]%

[Allocation Guidelines:
[1. Currently, you can select up to [1] of the Index Protection Strategy Index Options.
2. Currently, you can select up to [4] of the Index Performance Strategy Index Options.
3. Currently, you can select up to [4] of the Index Guard Strategy Index Options.
4. Currently, you can select up to [4] of the Index Precision Strategy Index Options.
5. Allocations must be made in whole percentages.]]

Index Options:
[Index Protection Strategy Index Options
Index
Minimum Declared Protection Strategy Credit for all Index Years
[S&P 500® Index
[0.10]%]]

[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 Guard Strategy Index Options
Index
Floor 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]%]]







S40877-NF
 

Index 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]%]]

 [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 North America ("Allianz"). 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. Allianz 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 North America. 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 NO LIABILITY WITH RESPECT TO THE PRODUCT(S).]

[ The Russell 2000® Index is a trademark of Russell Investments and has been licensed for use by Allianz Life Insurance Company of North America. 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.]
S40877-NF