WAIVER OF WITHDRAWAL CHARGE RIDER
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This rider forms a part of the Base Contract to which it is attached and is
effective as of the Issue Date of the Base Contract. In the case of a conflict
with any provision in the Base Contract, the provisions of this rider will
control. Defined terms and contractual provisions are set forth in the Base
Contract or are added in this rider. This rider will terminate as indicated in
the CONDITIONS FOR TERMINATION OF THIS RIDER section.
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The purpose of this rider is to provide a waiver of Withdrawal Charge based on
conditions described in the rider.
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WAIVER OF WITHDRAWAL CHARGE PROVISION
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WITHDRAWAL CHARGE WAIVER After the first Contract Year, you can make a
withdrawal without incurring a Withdrawal Charge
when the following conditions occur:
(a) an Owner, or the Annuitant if the
contract is owned by a non-individual,
is confined to a Skilled Nursing
Facility or Hospital;
(b) such confinement is for a period of at
least 90 consecutive days; and
(c) a licensed physician certifies in
writing that such continued confinement
is necessary.
Proof of confinement to a Skilled Nursing
Facility or Hospital must be provided in a form
satisfactory to the Company. The proof we may
require for the waiver of the Withdrawal Charge
shall include, but not be limited to, written
certification from a licensed physician
performing within the scope of his or her
license.
A Skilled Nursing Facility is an institution
that is licensed by the state in which it is
located to provide skilled nursing care,
intermediate nursing care or custodial nursing
care. A Hospital is an institution which is
licensed as a hospital by the state in which it
is located, is supervised by a staff of
licensed physicians and operates primarily for
the care and treatment of sick and injured
persons as inpatients for a charge.
The licensed physician must not be the Owner,
Joint Owner, Annuitant, Joint Annuitant, or the
spouse, parent or child of the Owner, Joint
Owner, Annuitant, or Joint Annuitant.
This waiver will not apply if on the Issue Date
the Owner or Joint Owner was confined in a
Skilled Nursing Facility or Hospital.
Withdrawals of amounts under the Base Contract
or this rider may be subject to a 10% tax
penalty in addition to any income taxes due.
You should consult your tax advisor before
making a withdrawal.
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GENERAL PROVISIONS
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CONDITIONS FOR TERMINATION This rider will terminate upon the termination
OF THIS RIDER of the Base Contract.
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GLOSSARY
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DEFINITIONS Definitions specific to this rider that are not
in the Base Contract follow.
BASE CONTRACT The contract to which this rider is attached.
In all other respects the provisions, conditions, exceptions and limitations
contained in the Base Contract remain unchanged.
Signed for the Company at its home office.
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA
/s/Xxxxx X. Xxxxxxxx /s/Xxxxxxx X. Xxxxxxxx
Xxxxx X. Xxxxxxxx Xxxxxxx X. Xxxxxxxx
Secretary President
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