0000845775-14-000041 Sample Contracts

EX-99.B4.a. Variable Indexed Annuity Contract Allianz Life Insurance Company of New York [One Chase Manhattan Plaza, 37th Floor New York, NY 10005-1423]
Variable Indexed Annuity Contract • May 2nd, 2014 • 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 increasing or decreasing depending on the experience of the Variable Account and Index Options. Investment in the contract may result in a loss of Purchase Payments. Contract Value 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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