Allianz Life Insurance Company of North America [PO Box 561 Minneapolis, MN 55440-0561]
Allianz Life Insurance Company
of North America
[PO Box 561
Minneapolis, MN 55440-0561]
[800.624.0197]
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Individual Flexible Purchase Payment Variable Deferred
Annuity Contract
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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 contains a
Market Value Adjustment which may result in either an upward or downward adjustment if you take a Partial Withdrawal or a Full Withdrawal. 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.
[
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] [Xxxxxxxx Xxxxx] [Xxxxxx X. Xxxxx]
Secretary President and CEO
RIGHT TO EXAMINE: This contract can be returned within 10 days after
you receive it. It can be mailed or delivered to either us or the representative 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. The Contract
Value will not be adjusted for any MVA. 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 located on the
Contract Schedule. If we so allocate Purchase Payments, we refund the greater of the Purchase Payments less any Withdrawals and less any fees or charges that are not imposed by us that you have directed us to pay from
this contract, 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
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3
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Definitions
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4
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Purchase Payments
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6
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Variable Account
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7
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Contract Value
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7
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Transfers
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7
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Contract Charges
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8
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Market Value Adjustment
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10
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Withdrawals
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11
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Annuity Payments
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12
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Death Benefit
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14
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Ownership
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15
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General Provisions
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16
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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.
Allocation Options
The Index Options available to you.
Annuitant
An individual whose Age determines the 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, in a form that is satisfactory to us, and that is received by the Service Center within any timelines provided on such form.
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, except, with regard to the Interim Fund(s), when an Interim Fund does not value its shares. Our Business Day closes when
regular trading on the New York Stock Exchange closes, which is usually at 4:00 p.m. Eastern Time. We process any instructions received after the close 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.
Cash Value
The Cash Value is equal to the Contract Value adjusted for any Full MVA minus any final Contract Charges.
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Definitions continued from the previous page
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Charge Base
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 or Withdrawals and adjusted for any Market Value Adjustment and 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 Market Value Adjustment 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).
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.
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.
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Definitions continued from the previous page
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Purchase Payment
Any payment you make to this contract.
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).
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Purchase Payments
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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 prior 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 of the first Contract Year. 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
If the Issue Date is the Index Effective Date, we allocate Purchase Payments to one or more of the Allocation Options according to your allocation instructions on the Index
Effective Date. 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 Allocation 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 Allocation Options according to your allocation instructions on the Index Effective Date.
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 Contract Value held in the Interim Fund(s) and any Additional Purchase Payments we receive on the Index Anniversary among your selected Allocation Options according to your most recent allocation instructions.
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 most recent allocation instructions must comply with the Allocation Guidelines shown on the Contract Schedules.
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Variable Account
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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 corresponding to the Interim Fund(s).
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Contract Value
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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, the deduction of Contract Charges, and the investment performance
of the Interim Fund(s).
We place Purchase Payments you allocate to the Allocation 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, 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, 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 value 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
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During the Accumulation Phase, you can transfer the Contract Value in an Allocation Option into another Allocation 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 clearly comply with the Allocation Guidelines shown on the Contract Schedules.
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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
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Product Fee
The Product Fee 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, when paying the Death
Benefit as noted under Death Benefit Payment Options, and when calculating Annuity Payments as noted under How we calculate Annuity Payments. 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 Allocation Option and Interim Fund(s). The deduction of the Product Fee reduces the Contract Value but it does not
reduce the Annual Contribution Amounts and is not subject to a Partial MVA. The deduction of the Product Fee does not reduce the amount we use to determine the Free Withdrawal Privilege, 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, you annuitize the contract, 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. We waive this charge as follows:
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During the Accumulation Phase if the Contract Value on the Contract Anniversary 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.
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 Allocation 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 does not reduce the Annual Contribution Amounts and is not subject to a Partial MVA.
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Contract Charges continued from previous page
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Advisory Fee
You may incur an Advisory Fee for investment advice recommendations associated with this contract. You may choose to have us pay all of an Advisory Fee for this contract to
the Financial Professional from this contract by notifying us in an Authorized Request. If you choose to not have us pay the Advisory Fee from this contract, you are responsible for the Advisory Fee using assets outside of this contract. The Advisory
Fee is not a fee or charge we impose in this contract.
If you choose to have us pay an Advisory Fee from this contract, the total Advisory Fee Deductions in a Contract Year may not exceed the Maximum Annual Advisory Fee
Percentage shown on the Contract Schedule.
Each of the Advisory Fee Deductions is a percentage equal to the amount of the fee being paid divided by the Contract Value. The Contract Value is the value at the end of the
Business Day that an Advisory Fee is deducted after all other transactions are processed. All Advisory Fee Deductions for that Contract Year are added together to determine the total Advisory Fee Deductions for that Contract Year. Any amount of an
Advisory Fee Deduction that exceeds or causes the total Advisory Fee Deductions to exceed the Maximum Annual Advisory Fee Percentage for that Contract Year, will not be paid.
When we deduct an Advisory Fee, we deduct it proportionately from each Allocation Option and Interim Fund(s), unless we receive alternate instructions. The deduction of an Advisory Fee
reduces the Contract Value on the Business Day the fee is deducted. The deduction of an Advisory Fee does not reduce the amount we use to determine the Free Withdrawal Privilege, does not reduce the amount available as a Required Minimum Distribution,
and is not treated as a Withdrawal when we compute any guaranteed value(s) under this contract. The deduction of an Advisory Fee does not reduce the Annual Contribution Amounts and is not subject to a Partial MVA.
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Market Value Adjustment
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The Market Value Adjustment (MVA) is a positive or negative adjustment that will apply to the Contract Value as described below. The maximum potential positive adjustment will always be the
same as the maximum potential negative adjustment.
MVA Period
On the Index Effective Date and on subsequent Index Anniversaries, the MVA Period begins and the Annual Contribution Amount for that Index Year is established. The MVA Period is the length of
time during which an MVA would apply for each Annual Contribution Amount as described below. The Annual Contribution Amount is equal to the Purchase Payments in the Interim Fund(s), adjusted for Withdrawals, since the prior Index Anniversary. Any
Purchase Payments received on the Index Anniversary will be included in that Index Year’s Annual Contribution Amount.
Any Purchase Payment that we receive on or before the Index Effective Date is included in the Annual Contribution Amount for the first Index Year. The Annual Contribution Amount for the
second Index Year is equal to the Purchase Payments in the Interim Fund(s), adjusted for Withdrawals, since the Index Effective Date. The MVA Period is shown on the Contract Schedule.
We take each Partial Withdrawal from the contract in the following order:
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from any Contract Value in the Interim Fund(s).
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from the Annual Contribution Amounts that are beyond the MVA Period.
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from the amounts available under the Free Withdrawal Privilege and Required Minimum Distributions.
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from the Annual Contribution Amounts that are within the MVA Period on a first-in-first-out (FIFO) basis. Withdrawal from these Annual Contribution Amounts is subject to a Partial
MVA.
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Any contract earnings.
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Any Withdrawals taken under the Free Withdrawal Privilege or as Required Minimum Distributions do not reduce the Annual Contribution Amount.
MVA Reference Rate
The MVA Reference Rate is the yield of the MVA Reference Rate Index. For each Annual Contribution Amount, we set the initial MVA Reference Rate equal to
the MVA Reference Rate at the end of the Business Day that begins the MVA Period.
MVA Factor
The MVA Factor is the factor used to calculate the MVA for each Annual Contribution Amount.
The MVA Factor is equal to (A/B)t -1, where:
A is 1 plus the inital MVA Reference Rate.
B is 1 plus the MVA Reference Rate at the end of the last Business Day prior to the date that the MVA is
applied.
t is the number of days from the date the MVA is applied to the next Index Anniversary, divided by 365, plus the number of whole years remaining in the Annual Contribution Amount’s MVA
Period.
Full MVA
The Full MVA is the dollar amount by which the Contract Value is adjusted when calculating the Cash Value if you take a Full Withdrawal or Annuity Payments or we pay the Death Benefit. The
Full MVA is equal to the sum of the MVAs for each Annual Contribution Amount that is within an MVA Period. The MVA for each Annual Contribution Amount is equal to the Annual Contribution Amount multiplied by the MVA Factor. The absolute value of the
Full MVA will never exceed the MVA Limit multiplied by the Contract Value. The MVA Limit is shown on the Contract Schedule.
Partial MVA
The Partial MVA is the dollar amount by which the Contract Value is adjusted if you take a Partial Withdrawalthat is subject to an MVA. We calculate Partial MVAs using the contract values at
the end of the Business Day on the day of, but immediately before we process the Partial Withdrawal. The Partial MVA is equal to the sum of each of the MVAs for each Annual Contribution Amount that is within an MVA Period and will be reduced by the
Partial Withdrawal. The MVA for each Annual Contribution Amount is equal to the amount of Purchase Payment being withdrawn from that Annual Contribution Amount multiplied by the MVA Factor. The Partial MVA will be a
positive adjustment to the Contract Value if the result is positive and it will be a negative adjustment to the Contract Value if the result is negative. The absolute value of the Partial MVA will never exceed the MVA Limit multiplied by the
Partial Withdrawal.
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Withdrawals
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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. When you request a Partial Withdrawal, the total Contract Value will decrease by the amount you request, and will be adjusted by the corresponding Partial MVA.
We deduct Partial Withdrawals first from the Interim Fund(s) then proportionately from the Allocation Options, unless we receive alternate instructions. Partial Withdrawals deducted from the
Interim Fund(s) will not be adjusted by a corresponding Partial MVA. 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 application of the Partial MVA would be less than the Minimum Required Value shown on the Contract Schedule, we treat your request as a
Full Withdrawal.
Free Withdrawal Privilege
Each Index Year you can take multiple Withdrawals without applying a Partial MVA if, when added together, they do not exceed the Free Withdrawal Amount shown on the Contract Schedule. Any
unused Free Withdrawal Privilege in one Index Year is not added to the Free Withdrawal Amount available in the next year. If you take a Full Withdrawal, we apply a Full MVA with no reductions for the Free Withdrawal Privilege.
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. A Partial MVA will not apply at the time you take a Required Minimum Distribution, but it will reduce your Free Withdrawal Amount and any other contract values accordingly. A Required Minimum Distribution does not reduce the Annual Contribution Amounts. 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.
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. A Partial MVA will not apply at the time you take a Required Minimum Distribution, but it will reduce your Free Withdrawal Amount and any other contract values accordingly. A Required Minimum Distribution does not reduce the Annual Contribution Amounts. 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.
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Annuity Payments
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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 the Annuity Payments would not be greater than or equal to the Minimum
Annuity Payment, 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 or the monthly Annuity Payments are less than the Minimum Annuity Payment, we
will make monthly Annuity Payments, according to Option C – Life with a 10-year guaranteed period.
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 greater of the Cash Value or the Contract Value determined on the Annuity Date to the surviving individual Owner, or the Beneficiary(s) 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 original Owner, the last surviving Owner’s Beneficiaries, or to the last surviving Owner’s estate if there are no remaining or named Beneficiaries.
How we calculate Annuity Payments
We calculate Annuity Payments on the Annuity Date using the greater of the Cash Value or Contract Value, and current purchase rates for the Annuity Option you select. We deduct the final
Product Fee before calculating the Annuity Payments. 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 greater of the Cash Value or 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.
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Annuity Payments continued from the previous page
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Annuity Options
Option A – Guaranteed period
We will pay Annuity Payments for a guaranteed period. At the end of the guaranteed period, Annuity Payments will terminate. The guaranteed period must be 10 years. 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
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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, replacing all the primary Beneficiaries previously named,
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 greater of the Cash Value or Contract Value 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 Allocation Options until we receive his or her Valid Claim.
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 regulations 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 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 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.
If the contract continues, if the Cash Value is greater than the Contract Value, the difference between the two values will be placed in the Interim Fund(s). On the next Index Anniversary,
we then allocate the Contract Value in the Interim Fund(s) among your selected Allocation Options according to your most recent allocation instructions.
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Death Benefit continued from the previous page
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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 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 within their portion of the contract among the Allocation 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.
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 before calculating Annuity Payments. 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.
If no Death Benefit Payment Option is selected, we default payment to Option B.
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 after receiving the first Valid Claim from any one Beneficiary until there has
been a complete distribution of the Death Benefit.
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Ownership
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Assignment of this Contract
You may, by Authorized Request, assign or otherwise transfer specific rights under this contract during the Accumulation Phase. 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
You may, by Authorized Request and our written consent, change ownership of this contract to a new Owner during the Accumulation Phase. 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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Ownership continued from the previous page
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Change of Annuitant
If you have an individually owned non-qualified contract, 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.
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 contigent 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.
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General Provisions
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Entire Contract
We have issued this contract in consideration of the Initial Purchase Payment. This contract, any amendments, any endorsements, and any riders together are the Entire Contract.
Incontestability of this Contract
We will not contest this contract, except as described in the “Misstatement of Age or Gender” provision.
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 any fees or charges that are not imposed by us that you have directed us to pay from this contract, 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.
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General Provisions continued from the previous page
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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 (including the MVA Reference Rate) 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:
• 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 Allocation 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.
If the MVA Reference Rate is not Published
If the MVA Reference Rate is not published on any day on which an MVA is calculated, we will use the MVA Reference Rate for the most recent day it was published.
Who can make changes in this contract
Only our President together with our Secretary has the authority to make any changes to this contract. Any change must be in writing.
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 whether or not there was a provision for taxes and whether or
not it was sufficient.
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 Market Value Adjustment. 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 or
Beneficiary.
Protection of the Death Benefit
To the extent permitted by law, the Death Benefit will not be subject to claims of creditors.
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General Provisions continued from the previous page
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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 contains a Market Value Adjustment which may result in either an upward or downward adjustment if you take a
Partial Withdrawal or a Full Withdrawal. 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.
