0000845775-12-000107 Sample Contracts

EX-99.B4.a. Individual Variable Annuity Base Contract
Allianz Life of Ny Variable Account C • November 19th, 2012

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. Contract Value in the Variable Account is not guaranteed as fixed dollar amounts. This contract is nonparticipating, with no dividends payable. Benefits available under this contract are not less than those required by New York statute.

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