CONTRACT OWNER: [John Doe] CONTRACT NUMBER: [??687456]Allianz Life Variable Account B • January 31st, 2000
Company FiledJanuary 31st, 2000
Social Security Number Date of Birth Sex ____Female (If the Contract Owner is a ____Male Daytime Telephone ( ) trust, list the date(s) of birth for the beneficial owner(s)) ______________________________________________________________________________Allianz Life Variable Account B • January 31st, 2000
Company FiledJanuary 31st, 2000