Allianz Life Insurance Company of North America 1750 Hennepin Avenue Minneapolis, MN 55403-2195 A Stock Company This is a legal Contract between the Contract Owner (referred to in this Contract as you and your) and Allianz Life Insurance Company of...Annuity Contract • July 6th, 1999 • Allianz Life Variable Account B
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)) ______________________________________________________________________________Flexible Premium Variable Annuity • July 6th, 1999 • Allianz Life Variable Account B
