Allianz Life Insurance Company of North America
Allianz Life Insurance Company of North America
[PO Box 561
Minneapolis, MN 55440-0561]
[800.624.0197]
Individual Flexible Purchase Payment Variable Deferred
Annuity Contract
Purchase Payments we receive for this contract accumulate to provide Annuity Payments or a Death
Benefit. This is a variable annuity contract with Contract Value increasing or decreasing depending on the experience of the Variable Account and Index Options. This
contract is nonparticipating, with no dividends payable. Benefits available under this contract are not less than those required by statute of the state in which this contract is issued.
Signed for the Company at its home office on the Issue Date.
Allianz Life Insurance Company
Of North America
By: /s/ XXXXXXXX XXXXX
[Xxxxxxxx Xxxxx]
Secretary
By: /s/ XXXXXXX X. XXXXXX
[Xxxxxxx X. Xxxxxx]
President and CEO
RIGHT TO EXAMINE: This contract can
be returned within 10 calendar days after you receive it. It can be mailed or delivered to either us or the financial professional who sold it. Return of this contract by mail is effective on being postmarked, properly addressed and postage paid. We
promptly refund the Contract Value. This may be more or less than the Purchase Payments. We have the right to allocate Purchase Payments to the Interim Fund(s) until the end of the Right to Examine period. The Interim Fund(s) are listed on the
Contract Schedule. If we so allocate Purchase Payments, we refund the greater of the Purchase Payments less any Withdrawals, or the Contract Value.
This is a legal contract between you and the Company.
Read this contract carefully.
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Table of Contents
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Contract Schedule 3
Definitions 4
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Definitions
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Some of the terms found in this contract are defined below. Additional terms are defined throughout this contract where they are used. Section
titles, provision titles, and terms used on the Contract Schedule are also capitalized to help you easily recognize them.
We, Our, Us, and the Company
Allianz Life Insurance Company of North America. The terms We, Our, and Us may not be capitalized throughout this contract.
You, Your
The Owner of this contract. The terms You and Your may not be capitalized throughout this contract. The term Contract Owner
may also be used to mean Owner in some endorsements or riders.
Accumulation Phase
The period of time beginning on the Issue Date and before you begin Annuity Payments. The Accumulation
Phase ends on the earliest of the following.
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The Business Day we process your request for a Full Withdrawal.
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The Business Day before the Annuity Date.
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The Business Day that the Service Center receives a Valid Claim from all Beneficiaries upon the death of an Owner (or Annuitant if
the Owner is a non-individual), unless this contract is continued by the deceased Owner’s Spouse.
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Age
An individual’s age on his or her most recent birthday, unless otherwise specified.
Annuitant
An individual whose Age determines the Annuity Payments under Annuity Options with lifetime Annuity Payments. You may be an
Annuitant or you may name someone else. The Annuitant is shown on the Contract Schedule.
Annuity Date
The date Annuity Payments begin.
Annuity Phase
The period of time beginning on the Annuity Date during which we make Annuity Payments. The Annuity Phase terminates on the
earliest of the following.
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Under Annuity Option A, at the end of the guaranteed period.
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Under Annuity Option B, the death of the Annuitant.
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Under Annuity Option C, the death of the Annuitant and the end of the guaranteed period.
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Under Annuity Options F and G, the death of the last surviving Joint Annuitant.
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Authorized Request
A request that is received by the Service Center in good order within any timelines provided.
Beneficiary
An individual or non-individual entitled to the Death Benefit under this contract.
Business Day
Each day on which the New York Stock Exchange is open for trading. Our Business Day ends when regular
trading on the New York Stock Exchange ends, which is usually at 4:00 p.m. Eastern Time. We process any instructions received at or after the end of any Business Day on the next Business Day. If any calculations or Contract Charges fall on a day that
is not a Business Day, they will be processed on the next Business Day, unless otherwise specified.
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Definitions continued from the previous page
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Cash Value
The Cash Value is equal to the Contract Value minus any Withdrawal Charges minus any final Contract Charges.
Charge Base
If your contract has a Product Fee, we base the Product Fee on the Charge Base. On the Issue Date,
the Charge Base is equal to the Initial Purchase Payment. On each Quarterly Contract Anniversary, the Charge Base is equal to the Contract Value at the end of the Business Day after we process any Additional Purchase Payments, Withdrawals including
any Withdrawal Charges, Contract Charges and, if this is also an Index Anniversary, after we apply any credits.
At the end of each Business Day, we:
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Increase the Charge Base by the amount of any Additional Purchase Payments received that day; and
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Reduce the Charge Base proportionately by the percentage of any Contract Value withdrawn that day, including any Withdrawal Charges
and Contract Charges.
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Contract Anniversary
A twelve-month anniversary of the Issue Date or any subsequent twelve-month Contract Anniversary.
Contract Year
A period of 12 months. The first Contract Year begins on the Issue Date. Subsequent Contract Years
begin on the Contract Anniversaries.
Index Anniversary
A twelve-month anniversary of the Index Effective Date or any subsequent twelve-month Index Anniversary.
Index Effective Date
The first day of the first Index Year. The Index Effective Date is shown on your Index Options
statement. The Index Effective Date can be any Business Day from the Issue Date up to and including the first Quarterly Contract Anniversary. However, it cannot be the 29th, 30th, or 31st of a month. If the Index
Effective Date would occur on the 29th, 30th, or 31st of a month, or on a day that is not a Business Day, we change the Index Effective Date to be the next available Business Day.
Index Options
The Index Options available to you are shown on the Index Options Contract Schedule(s). If the term Allocation Options is used
in any attached amendment, endorsement or rider, the term shall have the same meaning as Index Options.
Index Year
A period of 12 months. The first Index Year begins on the Index Effective Date. Subsequent Index Years
begin on the Index Anniversaries.
Issue Date
The first day this contract is effective. The Issue Date is shown on the Contract Schedule.
Joint Annuitant
You can add a Joint Annuitant for the Annuity Phase subject to our approval. If we allow Joint Annuitants, we determine
Annuity Payments using the Ages of both Joint Annuitants.
Joint Owner
Joint Owners have equal contract Ownership rights and must authorize the exercise of these rights in
writing, unless otherwise allowed by us. If Joint Owners are named, all references to Owner shall mean Joint Owners.
Maximum Annuity Date
The latest date by which Annuity Payments must begin. The Maximum Annuity Date is shown on the Contract Schedule.
Owner
A purchaser of this contract, who is entitled to the ownership rights described in this contract. Owners are shown on the
Contract Schedule.
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Definitions continued from the previous page
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Payee
The individual or non-individual to whom we make Annuity Payments. Generally we require the Owner to be the Payee, but we may
allow you to name a different Payee subject to our approval.
Purchase Payment
Any payment you make that we accept into this contract. We do not accept Purchase Payments received on
the same Business Day as a Full Withdrawal or Right to Examine Request.
Quarterly Contract Anniversary
A three-month anniversary of the Issue Date or any subsequent three-month Quarterly Contract Anniversary.
Service Center
The office shown at the top of the first page of your contract.
Spouse
An individual who is recognized as a spouse under federal law.
Valid Claim
An Authorized Request of the Death Benefit payment option, due proof of death, and any required governmental forms. Due proof
of death includes a certified copy of the death certificate, a decree of court of competent jurisdiction as to the finding of death, or any other proof satisfactory to us. Due proof of death is required only if we have not already received it.
Variable Account Value
The sum of the values in the Interim Fund(s).
Purchase Payments
Initial Purchase Payment
The Initial Purchase Payment is all Purchase Payments we receive on the Issue Date and is shown on the Contract Schedule. The
Initial Purchase Payment cannot be greater than the Maximum Total Purchase Payments shown on the Contract Schedule without our approval.
Additional Purchase Payments
Additional Purchase Payments are Purchase Payments we receive during the Accumulation Phase and before
the first Valid Claim. Additional Purchase Payments must be greater than or equal to the Minimum Additional Purchase Payment shown on the Contract Schedule. We may decline any Additional Purchase Payment. Each Index Year during the Accumulation Phase
total Purchase Payments cannot be greater than the total amount of Purchase Payments received before the first Quarterly Contract Anniversary. You may pay Additional Purchase Payments up to that amount for the remainder of the first Index Year. Total
Purchase Payments cannot be greater than the Maximum Total Purchase Payments without our prior approval.
No Default
This contract is not in default if you do not make Additional Purchase Payments.
Allocation of Purchase Payments
We place Purchase Payments in the Interim Fund(s) until the Index Effective Date. If the Issue Date is the Index Effective
Date, we then allocate Purchase Payments to one or more of the Index Options according to your allocation instructions. However, if we exercise our right to allocate to the Interim Fund(s) during the Right to Examine Period, we will allocate the
Initial Purchase Payment to the Interim Fund(s) until the end of the Right to Examine Period. If your requested Index Effective Date would occur during this time, we change your Index Effective Date to the next Business Day after the Right to Examine
Period that is not the 29th, 30th or 31st of the month. We will then allocate your Contract Value among your selected Index Options according to your allocation instructions on the Index Effective Date.
If the Issue Date is not the Index Effective Date, any Purchase Payment that we receive before the
Index Effective Date, we place in the Interim Fund(s) until the Index Effective Date. We will then allocate your Contract Value among your selected Index Options according to your allocation instructions on the Index Effective Date.
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Purchase Payments continued from the previous page
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We will place any Additional Purchase Payments we receive after the Index Effective Date in the Interim Fund(s) until the
next Index Anniversary. On the next Index Anniversary, we will allocate the Variable Account Value held in the Interim Fund(s) and any Additional Purchase Payments we receive before the end of the Business Day on the Index Anniversary among your
selected Index Options according to your allocation instructions. If the Index Anniversary is not a Business Day, we must receive the Additional Purchase Payments before the end of the Business Day prior to the Index Anniversary.
If at any time we have more than one Interim Fund available, you may elect which Interim Fund to which you would like to have
your Initial and any Additional Purchase Payments allocated.
Your allocation instructions must comply with the Allocation Guidelines shown on the Contract Schedules.
Variable Account
The Variable Account is shown on the Contract Schedule. It consists of assets we have set aside and
have kept separate from the rest of our assets and those of our other separate accounts. The assets of the Variable Account, equal to reserves and other liabilities of this contract and all other contracts issued through the Variable Account, will
not be charged with liabilities arising out of any other business we may conduct.
The Variable Account assets are divided into subaccounts which invest in the Interim Fund(s).
Contract Value
The Contract Value is equal to the sum of the Index Option Values and the Variable Account Value. The Index Option Values
are the values in a selected Index Option as discussed in the attached riders.
How the Variable Account Value increases and decreases
The Variable Account Value increases and decreases based on Purchase Payments, transfers out of the subaccounts, Withdrawals
(including any Withdrawal Charges), the deduction of Contract Charges, and the investment performance of the Interim Fund(s).
We place Purchase Payments you allocate to the Index Options into subaccounts of the Variable Account.
Each subaccount invests exclusively in one Interim Fund. We use Accumulation Units to account for all amounts allocated to or withdrawn from each subaccount as a result of Purchase Payments, Withdrawals (including any Withdrawal Charges), transfers
out of the subaccounts, or the deduction of Contract Charges. We determine the Variable Account Value by multiplying the number of subaccount Accumulation Units by the subaccount’s Accumulation Unit Value and then adding these results together.
Number of Accumulation Units
On the Issue Date, the number of Accumulation Units in each subaccount is equal to the Initial Purchase Payment amount
allocated to that subaccount, divided by that subaccount’s Accumulation Unit Value.
At the end of each Business Day, we adjust the number of Accumulation Units in each subaccount as follows. Additional
Purchase Payments will increase the number of Accumulation Units. Withdrawals (including any Withdrawal Charges), transfers out of subaccounts, and the deduction of any Contract Charges will decrease the number of Accumulation Units. The change in
the number of Accumulation Units is equal to the net amount allocated to or deducted from the subaccount, divided by that subaccount’s Accumulation Unit Value.
Accumulation Unit Value
We arbitrarily set the initial Accumulation Unit Value for each subaccount. At
the end of each Business Day for each subaccount, we multiply the Accumulation Unit Value at the end of the prior Business Day by the percentage change in price of an Interim Fund(s) since the prior Business Day. The percentage change includes the
market performance of the Interim Fund(s).
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Transfers
During the Accumulation Phase, you can transfer the Contract Value in an Index Option into another Index Option by providing
an Authorized Request. Transfers can only occur on the Index Effective Date and on subsequent Index Anniversaries by providing an Authorized Request.
All Transfers are subject to the following:
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We may limit Transfers until the end of the Right to Examine period.
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Any Transfer request must comply with the Allocation Guidelines shown on the Contract Schedule.
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Suspension of Payments or Transfers
We may suspend or postpone Transfers or payments for Withdrawals for any period when:
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The New York Stock Exchange is closed, other than customary weekend and holiday closings.
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Trading on the New York Stock Exchange is restricted.
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An emergency, as determined by the Securities and Exchange Commission, exists as a result of which disposal of the Interim Fund(s)
shares are not reasonably practicable or we cannot reasonably value the Interim Fund(s) shares.
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During any other period when the Securities and Exchange Commission, by order, so permits for the protection of Owners.
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Contract Charges
Product Fee
If your contract has a Product Fee, it is shown on the Contract Schedule.
The Product Fee is assessed as a percentage of the Charge Base as an annualized rate that we accrue
each day during the Accumulation Phase and when paying the Death Benefit as noted under Death Benefit Payment Options. If any day that we are to accrue this charge is not a Business Day, we use the Charge Base at the end of the previous Business Day.
We deduct the Product Fee for each quarter on the earlier of the following: (a) the next Quarterly Contract Anniversary, or the next Business Day if the next Quarterly Contract Anniversary is not a Business Day; or (b) when we deduct the final
Product Fee. We deduct the Product Fee from the Contract Value on each Quarterly Contract Anniversary (or the next Business Day if the Quarterly Contract Anniversary is not on a Business Day) before we use that Contract Value to compute any
guaranteed value(s) under this contract.
When we deduct the Product Fee, we deduct it proportionately from each Index Option and Interim Fund(s). The deduction of the
Product Fee reduces the Contract Value, but is not subject to a Withdrawal Charge and does not reduce the Withdrawal Charge Basis(es). The deduction of the Product Fee does not reduce the amount we use to determine the Free Withdrawal Privilege or
the Withdrawal Charge Basis, and is not treated as a Withdrawal when we compute any guaranteed value(s) under this contract.
We deduct the final Product Fee on the Business Day you withdraw the total Contract Value, the last Business Day before the
Annuity Date, or when paying a Death Benefit as noted under the “Death Benefit Payment Options” provision. However, if on a Quarterly Contract Anniversary the Contract Value is less than the Product Fee, we deduct any remaining Contract Value to
cover the final Product Fee and reduce the Contract Value to zero.
Contract Maintenance Charge
Your annual Contract Maintenance Charge is shown on the Contract Schedule. During the Accumulation
Phase, we deduct the Contract Maintenance Charge from the Contract Value on the Contract Anniversary. If the Contract Anniversary is not a Business Day, we deduct the charge on the next Business Day. If you take a Full Withdrawal from your contract
(other than on a Contract Anniversary), we deduct the Contract Maintenance Charge. We deduct the Contract Maintenance Charge proportionately from each Index Option and Interim Fund(s). During the Annuity Phase, we deduct the Contract Maintenance
Charge proportionately from each Annuity Payment.
The deduction of the Contract Maintenance Charge is not subject to a Withdrawal Charge and does not reduce the Withdrawal
Charge Basis(es).
We waive the Contract Maintenance Charge as follows:
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During the Accumulation Phase if the Contract Value on the Contract Anniversary before we deduct any other Contract Charges is at
least equal to the Contract Maintenance Charge Waiver Minimum.
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During the Accumulation Phase if the Contract Value at the end of the last Business Day before you take a Full Withdrawal is at least equal to the
Contract Maintenance Charge Waiver Minimum.
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During the Annuity Phase if the Contract Value is at least equal to the Contract Maintenance Charge Waiver Minimum at the end of
the last Business Day before the Annuity Date.
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The Contract Maintenance Charge Waiver Minimum is shown on the Contract Schedule.
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Withdrawals
During the Accumulation Phase and before the first Valid Claim, you can request a Full or Partial Withdrawal from this
contract by providing an Authorized Request. We pay the amount of any Withdrawal within seven days of receipt of an Authorized Request unless the Suspension of Payments or Transfers provision of this contract is in effect.
Full Withdrawal
A Full Withdrawal is a request for the total Cash Value. We process a Full Withdrawal on the Business Day we receive an
Authorized Request, based on the values at the end of the Business Day. This contract terminates upon a Full Withdrawal.
Partial Withdrawals
A Partial Withdrawal is a request for an amount less than the total Cash Value. Each Partial Withdrawal
must be greater than or equal to the Minimum Partial Withdrawal shown on the Contract Schedule prior to the application of the Withdrawal Charge. When you request a Partial Withdrawal, the total Contract Value will decrease at the end of the Business
Day by the amount you request, plus any Withdrawal Charge. We withdraw from your Contract Value an amount that, after application of any Withdrawal Charge to the amount withdrawn, will provide the amount you requested.
We deduct Partial Withdrawals proportionately from the Index Options and Interim Fund. We deduct a Partial Withdrawal from
the Contract Value at the end of the Business Day that we process the Withdrawal request.
If the Contract Value after a Partial Withdrawal and any Withdrawal Charge would be less than the
Minimum Required Value shown on the Contract Schedule, we treat your request as a Full Withdrawal.
Withdrawal Charge
Upon a Full or Partial Withdrawal of this contract we assess a Withdrawal Charge. A Withdrawal Charge
applies if any part of a Withdrawal comes from a Purchase Payment that is still within the Withdrawal Charge period. We assess the Withdrawal Charge for each Purchase Payment against its Withdrawal Charge Basis, which is equal to the amount of the
Purchase Payment, less any portion of the Purchase Payments withdrawn (excluding any Penalty-Free Withdrawals), and less any Withdrawal Charges as outlined below. Penalty-Free Withdrawals include Withdrawals under the Free Withdrawal Privilege and
Waiver of Withdrawal Charge Rider, and if applicable, withdrawals taken as a Required Minimum Distribution. We do not reduce the Withdrawal Charge Basis(es) for Penalty- Free Withdrawals and amounts we deduct to pay Contract Charges. For purposes of
calculating any Withdrawal Charge we withdraw Purchase Payments on a first-in-first-out (FIFO) basis. We calculate the charge at the time of each Withdrawal and the total Withdrawal Charge is equal to the sum of the Withdrawal Charges for each
Purchase Payment withdrawn. We take each Withdrawal from your contract in the following order.
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Purchase Payments that are beyond the Withdrawal Charge period shown in the Withdrawal Charge Percentages Table. These Purchase
Payments no longer have a Withdrawal Charge Basis and are not subject to a Withdrawal Charge.
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Amounts that are available as Penalty-Free Withdrawals. These Withdrawals are not subject to a Withdrawal Charge, and do not reduce
the Withdrawal Charge Basis(es).
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Withdrawal Charge Basis(es) that are within the Withdrawal Charge period shown in the Withdrawal Charge Percentages Table on a FIFO basis. These
Withdrawals are subject to a Withdrawal Charge, which is equal to the Withdrawal Charge Basis for the portion of each Purchase Payment being withdrawn multiplied by its applicable Withdrawal Charge percentage. The total Withdrawal Charge is
equal to the sum of the Withdrawal Charges for each Withdrawal Charge Basis. These Withdrawals reduce the Withdrawal Charge Basis(es).
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Any contract earnings. This Withdrawal is not subject to a Withdrawal Charge and it does not reduce the Withdrawal Charge Basis.
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The Withdrawal Charge Percentages Table is shown on the Contract Schedule. The Withdrawal Charge does not apply to Annuity
Payments or death benefit payments.
Free Withdrawal Privilege
Each Contract Year you can take multiple Withdrawals up to the Free Withdrawal Amount shown on the Contract Schedule without
incurring a Withdrawal Charge. Any unused Free Withdrawal Privilege in one Contract Year is not added to the Free Withdrawal Amount available in the next year. If you take a Full Withdrawal, we assess a Withdrawal Charge with no reductions for the
Free Withdrawal Privilege.
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Withdrawals continued from the previous page
Required Minimum Distributions
If this contract is an Individual Retirement Annuity (IRA) or owned by a qualified retirement plan, you
may be required by the Internal Revenue Code to take Required Minimum Distributions. To satisfy such requirement for this contract only, you may take a withdrawal as a Required Minimum Distribution by providing us an Authorized Request. Such
withdrawal may not be greater than the Required Minimum Distribution of the current calendar year less any amount previously withdrawn as a Required Minimum Distribution or Partial Withdrawal. If you take a Required Minimum Distribution, it does not
reduce the Withdrawal Charge Basis(es) and is not subject to a Withdrawal Charge, but it will reduce your Free Withdrawal Amount and any other contract values accordingly. If you take a withdrawal and do not indicate through an Authorized Request
that it is a Required Minimum Distribution, it will be treated as a Partial Withdrawal.
Annuity Payments
This contract provides for Annuity Payments.
How Annuity Payments Begin
You may begin Annuity Payments by providing an Authorized Request. If you do not begin Annuity Payments
before the Maximum Annuity Date, we will begin Annuity Payments on the Maximum Annuity Date if the Contract Value on that date is greater than zero. Your requested Annuity Date must be on an Index Anniversary, is subject to our approval and cannot be
earlier than two years after the Issue Date or later than the last Annuity Date permitted by applicable state or federal law.
We make Annuity Payments according to the Annuity Option and payment frequency you select. You can select a monthly,
quarterly, semi-annual, or annual payment frequency. We send Annuity Payments to the Payee. For Annuity Payments to begin, we may require that Annuity Payments be greater than or equal to the Minimum Annuity Payment shown on the Contract Schedule. If
your selected payment frequency results in Annuity Payments that are less than the Minimum Annuity Payment, we will update your payment frequency to comply with the Minimum Annuity Payment requirement. If we are unable to satisfy the Minimum Annuity
Payment requriement, we may ask you to select a different Annuity Option. If the Annuity Payments would not be greater than or equal to the Minimum Annuity Payment under any Annuity Option or payment frequency, we reserve the right to require you to
take a Full Withdrawal and your contract will then terminate.
If you do not select an Annuity Option or payment frequency before the Maximum Annuity Date, we will make monthly Annuity
Payments according to Option C – Life with a guaranteed period of 10 years.
We may require proof of the Age and gender of an Annuitant before making any Annuity Payments. During the Annuity
Phase, you cannot change the Annuity Option or the payment frequency.
If a sole Owner dies during the Annuity Phase, and we are still required to make Annuity Payments under
the terms of the selected Annuity Option, the Beneficiary(ies) becomes the Owner(s) of this contract. If a Joint Owner dies during the Annuity Phase, and we are still required to make Annuity Payments under the terms of the selected Annuity Option,
the surviving Joint Owner becomes the sole Owner of this contract. Any remaining Annuity Payments will continue at least as rapidly as under the method of distribution in effect at such Owner’s death.
Under Annuity Options B, F, and G, if all Annuitants die on or after the Annuity Date and before we send the first Annuity
Payment, we will cancel the Annuity Payments and upon receipt of a Valid Claim we will pay the Contract Value determined on the Annuity Date to the surviving individual Owner, or the Beneficiary(ies) if there is no surviving Owner. If the Owner is a
non-individual, we pay the Owner.
Under Annuity Options A and C, if the Annuitant dies before the end of the selected guaranteed period, we make Annuity
Payments during the remaining guaranteed period in the following order based on who is still alive: the Payee, any surviving Owner, the last surviving Owner’s Beneficiary(ies), or to the last surviving Owner’s estate if there are no remaining or
named Beneficiary(ies).
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Annuity Payments continued from the previous page
How we calculate Annuity Payments
We calculate Annuity Payments on the Annuity Date using the Contract Value and current purchase rates for the Annuity Option
you select. We deduct the final Product Fee, if applicable, before calculating the Annuity Payments, but we do not deduct the Contract Maintenance Charge. Current purchase rates cannot be less than the rates in the Guaranteed Purchase Rate Table
shown on the Contract Schedule. The Guaranteed Purchase Rates are based on the Annuity Mortality Table and the Minimum Annual Annuity Payment Rate shown on the Contract Schedule. You may contact us at any time to get the current purchase rates that
we would use if you were to begin Annuity Payments at that time.
Annuity Payments are equal to the Contract Value, divided by $1,000, and then multiplied by the applicable purchase rate
for the Annuity Option you select. Annuity Payments will not change, unless as described in Annuity Option G – Joint and 2/3 Survivor.
Annuity Options
Option A – Guaranteed period
We will pay Annuity Payments for a guaranteed period of 10 years. At the end of the guaranteed period, Annuity Payments will terminate. The
Guaranteed Purchase Rates for Option A are shown in Table 1.
Option B – Life
We will pay Annuity Payments as long as the Annuitant is living. The last Annuity Payment will be the one that is due before
the Annuitant’s death. When the Annuitant dies, Annuity Payments will terminate. The Guaranteed Purchase Rates for select ages for Option B are shown in Table 2.
Option C – Life with a guaranteed period
We will pay Annuity Payments as long as the Annuitant is living. If the Annuitant dies before the end of
the guaranteed period, Annuity Payments will continue until the end of the guaranteed period. At the end of the guaranteed period, Annuity Payments will terminate. The guaranteed period must be 5 or 10 years. The Guaranteed Purchase Rates for select
ages for Option C are shown in Table 2.
Option F – Joint and survivor
You must name Joint Annuitants for this annuity option. We will pay Annuity Payments as long as either Joint Annuitant is
living. The last Annuity Payment will be the one that is due before the last surviving Joint Annuitant’s death. When both Joint Annuitants have died, Annuity Payments will terminate. The Guaranteed Purchase Rates for select ages for Option F are
shown in Table 3.
Option G – Joint and 2/3 survivor
You must name Joint Annuitants for this annuity option. We will pay Annuity Payments as long as both
Joint Annuitants are living. After the death of one Joint Annuitant, two-thirds of the original Annuity Payment amount will continue as long as the surviving Joint Annuitant is living. The last Annuity Payment will be the one that is due before the
last surviving Joint Annuitant’s death. When both Annuitants have died, Annuity Payments will terminate. The Guaranteed Purchase Rates for select ages for Option G are shown in Table 4.
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Death Benefit
Who receives the Death Benefit
If the sole Owner dies during the Accumulation Phase, we pay the Death Benefit to the Beneficiary(ies).
If a Joint Owner dies during the Accumulation Phase, the surviving Joint Owner automatically becomes the sole primary
Beneficiary and we pay the Death Benefit to the surviving Joint Owner.
If the Owner is a non-individual and the Annuitant dies during the Accumulation Phase, we pay the Death
Benefit to the Beneficiary(ies).
If a Beneficiary predeceases you, or dies within 120 hours of you, that Beneficiary’s interest in this contract ends,
unless your Beneficiary designation specifies otherwise. For multiple Beneficiaries, any surviving Beneficiaries receive equal portions of the Death Benefit unless your Beneficiary designation specifies unequal percentages. If you specify unequal
percentages, we pay the deceased Beneficiary’s percentage of the Death Benefit to the surviving Beneficiaries proportionally, unless you have specified otherwise.
If there are no surviving primary Beneficiaries, we pay the Death Benefit to the contingent Beneficiaries who survive
you. If there are no surviving Beneficiaries or if there is no named Beneficiary, we pay the Death Benefit to your estate or the Owner (if the Owner is a non-individual).
Death Benefit
During the Accumulation Phase, the Death Benefit is each surviving Beneficiary’s portion of the
Contract Value less any final Contract Charges, determined at the end of the Business Day we receive his or her Valid Claim.
Each Beneficiary’s portion of the Death Benefit remains in the Index Options until we receive his or
her Valid Claim and we either pay the Death Benefit or we receive alternate allocation instructions from the Beneficiary. If any portion of the Death Benefit is in the Interim Fund(s) on an Index Anniversary, we then allocate the Contract Value in
the Interim Fund(s) among the selected Index Options.
Payment of the Death Benefit
We require a Valid Claim before we pay any Death Benefit.
All Death Benefits are paid in accordance with applicable law or regulation governing Death Benefit payments under
Option A, B, or C.
Continuation of Contract by the Surviving Spouse
During the Accumulation Phase, the surviving Spouse of the deceased Owner who is a primary
Beneficiary may choose to continue their portion of this contract as the sole Owner instead of receiving payment of the Death Benefit. Continuation may be elected by providing us a Valid Claim, and this continuation will be effective when we receive
a Valid Claim.
If a Joint Owner is the surviving Spouse of the deceased Owner, he or she is eligible to continue this
contract as the sole Owner because the surviving Spouse automatically becomes the sole primary Beneficiary of the deceased Owner.
If this contract is owned by a qualified retirement plan or an IRA held by a third party custodian, the surviving Spouse of
the deceased Annuitant is eligible to continue this contract as the Annuitant through a direct rollover or transfer to his or her own IRA if the qualified retirement plan or IRA third party custodian is designated as the primary Beneficiary under
this contract and the surviving Spouse is designated as the sole primary beneficiary under the qualified retirement plan or IRA.
If a surviving Spouse continues this contract as the sole Owner, he or she may exercise all Ownership rights under this
contract.
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Death Benefit Payment Options
If death occurs during the Accumulation Phase, a Beneficiary must request that the Death Benefit be paid
by one of the payment options below or with our written agreement under a payment option other than Option A, Option B or Option C listed below. We do not deduct the Contract Maintenance Charge under these payment options.
Option A - A lump sum payment of the Death Benefit. We deduct
the final Product Fee, if applicable, before calculating the Death Benefit.
Option B - Deferral of
payment of the Death Benefit for up to five years from the date of the death of any Owner. During the deferral period, the Beneficiary can make transfers on an Index Anniversary within their portion of the contract among the Index Options. At the end
of the fifth year, any remaining Death Benefit is paid in a lump sum. If you select Option B, we continue to assess the Product Fee shown on the Contract Schedule, if applicable.
Option C - If the Beneficiary is an
individual, payment of the Death Benefit as Annuity Payments under Annuity Options A, B, or C paid over the lifetime of the Beneficiary or the guaranteed period as applicable. We deduct the final Product Fee, if applicable, before calculating Annuity
Payments. For purposes of this Option C, Annuity Payments do not have to begin on an Index Anniversary. With our written consent, other options may be available for payment over a period not extending beyond the life expectancy of the Beneficiary
under which we continue to assess the Product Fee shown on the Contract Schedule.
Any Beneficiary’s portion of the Death Benefit not applied to Annuity Payments under an Annuity Option within one year of the date of the Owner’s
death must be distributed within five years of the date of death.
If a Beneficiary requests a lump sum payment, we pay the amount from the Variable Account within seven days of receipt of a
Valid Claim from the Beneficiary, unless the Suspension of Payments or Transfers provision in this contract is in effect.
In cases of multiple Beneficiaries, we will continue to assess the Product Fee shown on the Contract Schedule, if applicable, after receiving
the first Valid Claim from any one Beneficiary until there has been a complete distribution of the Death Benefit.
Ownership
Assignment of this Contract
During the Accumulation Phase only, you may, by Authorized Request, assign or otherwise transfer specific rights under this
contract. We will record the assignment as of the date the Authorized Request is signed by you, unless you specify otherwise. We will not consent if the assignment or transfer would violate or result in noncompliance with any applicable state or
federal law or regulation. We will not be responsible for the validity or effect of the assignment, including the tax consequences of such assignment. We will not be liable to the assignee for any actions we take or payments we make before we consent
and record the assignment or transfer.
An absolute assignment is a change of Ownership. If you assign specific rights under this contract, you can exercise those
specific rights only with the written consent of the assignee. An assignment does not change the Annuitant or Beneficiary(ies). An assignment that is not an absolute assignment does not change the Owner.
Change of Ownership
During the Accumulation Phase only, you may, by Authorized Request and our written consent, change
ownership of this contract to a new Owner. We may refuse to consent to any change of ownership at any time on a non-discriminatory basis. We will not consent if the change in ownership would violate or result in noncompliance with any applicable
state or federal law or regulation. Upon consent, we will record the change of ownership, subject to our approval guidelines at the time of the request. An Ownership change will take effect as of the date you signed the Authorized Request. We will
not be responsible for the validity or effect of the change of ownership, including the tax consequences of such transfer. We will not be liable to the new Owner for any actions we take or payments we make before we consent and record the change of
ownership.
A change of ownership does not change the Annuitant or Beneficiary(ies). The new Owner can request a change of Annuitant or Beneficiary by
providing an Authorized Request.
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Change of Annuitant
For individually owned non-qualified contracts, you may, upon Authorized Request, change the Annuitant during the
Accumulation Phase.
For solely owned individual contracts, where the sole Owner is not the Annuitant, the sole Owner
automatically becomes the Annuitant if the Annuitant dies during the Accumulation Phase. The Owner may name another Annuitant at any time.
For jointly owned contracts, where neither Joint Owner is the Annuitant, the younger Joint Owner automatically becomes the
Annuitant if the Annuitant dies during the Accumulation Phase. The Joint Owners may name another Annuitant at any time. If instead the deceased Xxxxxxxxx was also a Joint Owner, the Joint Owners were Spouses, and the surviving Joint Owner continues
the Contract, the surviving Joint Owner automatically becomes the Annuitant and may name another Annuitant at any time.
For non-individually owned contracts, the Annuitant may not be changed, except as described in the Continuation of Contract by the Surviving
Spouse provision.
An Annuitant change takes effect as of the date you signed the Authorized Request, subject to our
approval guidelines at that time. We will not be liable for any actions we take or payments we make before the Service Center receives the Authorized Request.
Change of Beneficiary
You may, upon Authorized Request, change the Beneficiary(ies) subject to the following limitations.
For solely owned individual or non-individual contracts, you may change the Beneficiary(ies) at any time before an Owner’s
death, if individually owned, or before an Annuitant’s death, if non-individually owned.
For jointly owned contracts, you may change the contingent Beneficiary(ies) at any time. Upon the first Joint Owner’s
death, the surviving Joint Owner is the sole primary Beneficiary and may not be changed.
An irrevocable Beneficiary must give written consent before we will change the Beneficiary.
If an estate is the Beneficiary, the estate must be the sole primary Beneficiary, unless the Spouse is the sole primary
Beneficiary. If the Spouse is the sole primary Beneficiary, then an estate can be a contingent Beneficiary.
A Beneficiary change takes effect as of the date you signed the Authorized Request. We are not liable for any actions we take or payments we make
before the Service Center receives the Authorized Request.
General Provisions
Entire Contract
We have issued this contract in consideration of the application and Initial Purchase Payment we receive. This contract,
any amendments, any endorsements, and any riders together are the Entire Contract.
All statements made by or for you are considered representations and not warranties.
Incontestability of this Contract
We will not contest this contract, except as described in the “Misstatement of Age or Gender” provision.
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Misstatement of Age or Gender
If there is a misstatement of Age or gender of the Owner or Annuitant, we will correct the applicable Age or gender, except
as further described below.
Before Annuity Payments begin, if there is a misstatement of the Age of the Owner or Annuitant and this contract was issued after the Maximum
Issue Age, we will refund Purchase Payments paid minus any prior withdrawals, and we will void this contract. The Maximum Issue Age is shown on the Contract Schedule.
After the Annuity Date, if there is a misstatement of the Age or gender of the Annuitant, we recalculate the Annuity
Payments based on the correct Age and gender. If the misstatement caused an underpayment, we pay the Payee the difference in one payment. If the misstatement caused an overpayment, we reduce the next payment by the amount of the difference. If the
amount of the difference is larger than the next payment, we reduce the subsequent payment, and so on until the entire difference has been subtracted. If the future payments are insufficient to cover the difference, we bill the Payee for the amount
due. Any underpayment or overpayment will not include interest.
Annual Report
At least once each calendar year during the Accumulation Phase, we send you a report that shows contract activity and the
Contract Value.
No Dividends are Payable
This contract is nonparticipating. This contract does not participate in our profits or surplus.
Changes to an Index or Interim Fund
We will send notice to you and any assignee of record at your last known address if we add an Index or an Interim Fund. We
will send notice to you and any assignee of record at your last known address if we substitute an Index or Interim Fund, and any portion of your Contract Value is allocated to the Index or Interim Fund being substituted. An Index or Interim Fund may
be substituted with a new Index or Interim Fund because:
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the Index or Interim Fund is discontinued;
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we are unable to use the Index because changes to the Index make it impractical or expensive to purchase derivative securities to
hedge the Index;
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we are not licensed to use the Index or Interim Fund;
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if the method of calculation of the Index or Interim Fund values changes substantially resulting in significantly different
performance results; or
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it is determined in our sole discretion that such substitution is necessary.
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If required, we will seek regulatory approval prior to substituting an Index. If an Index or Interim Fund is renamed, we
will send notice of the new name to you and any assignee of record at your last known address.
If an Index or Interim Fund is Restricted from New Allocation
We may discontinue accepting new allocations into a specific Index Option or Interim Fund at any time.
We may discontinue accepting new allocations into an Interim Fund only if we offer more than one Interim Fund at a time. We will send notice to you and any assignee of record at your last known address if we discontinue accepting new allocations into
a specific Index Option and any portion of your Contract Value is allocated to the Index Option or Interim Fund, which we are restricting.
Who can make changes in this contract
Only our President together with our Secretary has the authority to make any changes to this contract or waive any provisions
of this contract. Any change must be in writing.
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Taxes
Taxes paid to any governmental entity results in an amount equivalent to the tax being charged against the Contract Value.
We may establish a provision for premium tax if we determine, in our sole discretion, whether taxes
have resulted from our receipt of Purchase Payments, or commencement of Annuity Payments. We may, at our discretion, pay taxes when due and deduct that amount from the Contract Value at a later date. This will not waive any right we may have to
deduct previously paid amounts at a later date.
We may establish a provision for federal income taxes, excise taxes or foreign withholding taxes not recovered if we
determine, in our sole discretion, that we will incur such tax as a result of the operation or investment experience of the Variable Account. We may deduct from the Contract Value for any income taxes incurred as a result of the operation of the
Variable Account.
We deduct any federal or state income withholding taxes from any payment we make, as required by applicable law.
Divorce
If Spouses divorce on or after the Issue Date, we will treat any request to transfer or divide benefits
under the contract as a request for a Full or Partial Withdrawal payable to you. The Full or Partial Withdrawal will be subject to any applicable taxes and Withdrawal Charges. The Full Withdrawal will also be subject to any final Contract Charges. If
we receive notice of divorce as an Authorized Request, we will remove one former Spouse from the contract as an Owner, Joint Owner, Annuitant and/or Beneficiary.
Protection of the Death Benefit
To the extent permitted by law, the Death Benefit will not be subject to claims of creditors.
Evidence of Survival
Where any benefits under this contract are contingent on a person being alive on a given date, we may require proof
satisfactory to us that the condition has been met.
Termination
The contract terminates when:
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the Accumulation Phase and/or the Annuity Phase terminates; or
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a Valid Claim has been received and all applicable Death Benefit payments have been made.
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The contract provisions that do not apply to our Annuity Payment obligations terminate on the Annuity Date.
Amendments
We may amend this contract as follows:
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To retain its qualification for treatment as an annuity, whether under state or federal law, including the following:
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The Internal Revenue Code, as amended.
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Internal Revenue Service Rulings and Regulations.
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Any requirements imposed by the Internal Revenue Service.
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To add benefits to the contract that are beneficial to you.
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Allianz Life Insurance Company of North America
[PO Box 561]
[Minneapolis, MN 55440-0561]
[800.624.0197]
Individual Flexible Purchase Payment Variable Deferred Annuity Contract
Purchase Payments we receive for this contract accumulate to provide Annuity Payments or a Death Benefit. This is a variable annuity contract with Contract Value increasing or decreasing depending on the experience of the Variable Account and Index Options. This contract is nonparticipating, with no
dividends payable. Benefits available under this contract are not less than those required by statute of the state in which this contract is issued.
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