0000845775-11-000062 Sample Contracts

Allianz Life Insurance Company of New York [One Chase Manhattan Plaza, 37th Floor New York, NY 10005-1423]
Individual Flexible Purchase Payment Variable Deferred Annuity Contract • December 21st, 2011 • Allianz Life of Ny Variable Account C

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, Annuity Payments, and Base Death Benefit increasing or decreasing depending on the experience of the Variable Account. Contract Value, Annuity Payments, and Base Death Benefit in the Variable Account are 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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