0001193125-14-179966 Sample Contracts

Individual Flexible Purchase Payment Variable Deferred Annuity Contract
Allianz Life Insurance Co of New York • May 2nd, 2014

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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