New York
(State or other jurisdiction of incorporation or organization)
|
6311
(Primary Standard Industrial Classification Code Number)
|
13-3191369
(I.R.S. Employer
Identification No.)
|
The information in this prospectus
is not complete and may be changed. We cannot sell the Allianz Index
Advantage+SM New York Variable Annuity until the Registration Statement filed with the Securities and Exchange
Commission is effective. This
prospectus is not an offer to sell the Contract and is not soliciting an offer to buy the
Contract in any state where the
offer or sale is not permitted.
|
5
|
||
10
|
||
14
|
||
|
14
|
|
|
14
|
|
|
16
|
|
17
|
||
|
17
|
|
|
18
|
|
|
18
|
|
|
18
|
|
18
|
||
|
18
|
|
|
19
|
|
|
20
|
|
|
21
|
|
|
21
|
|
|
22
|
|
|
22
|
|
|
23
|
|
|
25
|
|
|
26
|
|
|
26
|
|
|
26
|
|
1.
|
26
|
|
|
26
|
|
|
27
|
|
|
28
|
|
2.
|
29
|
|
|
29
|
|
|
29
|
|
|
29
|
|
|
30
|
|
|
30
|
|
|
30
|
|
|
30
|
3.
|
31
|
|
|
31
|
|
|
31
|
|
|
31
|
|
|
33
|
|
|
34
|
|
4.
|
34
|
|
|
35
|
|
|
35
|
|
|
36
|
|
|
39
|
|
|
41
|
|
|
43
|
|
|
44
|
|
|
45
|
|
|
46
|
|
5.
|
47
|
|
|
48
|
|
|
48
|
|
|
49
|
|
6.
|
50
|
|
|
50
|
|
|
50
|
|
|
50
|
|
|
52
|
|
|
53
|
|
|
53
|
|
|
53
|
|
7.
|
53
|
|
|
54
|
|
|
54
|
|
|
55
|
|
|
55
|
|
8.
|
55
|
|
|
55
|
|
|
55
|
|
|
56
|
|
9.
|
57
|
|
10.
|
60
|
|
|
61
|
|
|
61
|
|
|
62
|
11.
|
62
|
|
|
62
|
|
|
63
|
|
|
64
|
|
|
64
|
|
|
64
|
|
|
64
|
|
|
65
|
|
|
66
|
|
|
66
|
|
|
66
|
|
|
67
|
|
|
67
|
|
|
67
|
|
|
67
|
|
|
69
|
|
|
69
|
|
|
69
|
|
|
70
|
|
|
70
|
|
|
70
|
|
|
70
|
|
|
70
|
|
12.
|
70
|
|
|
70
|
|
|
71
|
|
|
71
|
|
|
71
|
|
|
73
|
|
|
73
|
|
|
73
|
13.
|
73
|
|
|
74
|
|
|
78
|
|
|
88
|
|
|
88
|
|
|
88
|
|
14.
|
95
|
|
96
|
||
|
96
|
|
|
96
|
|
|
97
|
|
|
97
|
|
99
|
||
101
|
||
102
|
||
Back Cover
|
||
|
Back Cover
|
|
FEES AND
EXPENSES
|
Prospectus
Location
|
||
Charges
for Early
Withdrawals
|
If you withdraw money from the Contract within six years of your
last Purchase Payment,
you will be assessed a withdrawal charge of up to 8% of the Purchase
Payment withdrawn,
declining to 0% over that time period. For example, if you invest
$100,000 in the Contract
and make an early withdrawal, you could pay a withdrawal charge of
up to $8,000.
In addition, if you take a full or partial withdrawal (including
financial adviser fees that you
choose to have us pay from this Contract) from an Index Option on a
date other than the
Term End Date, a Daily Adjustment will apply to the Index Option
Value available for
withdrawal. The Daily Adjustment also applies if before the Term End
Date you execute a
Performance Lock, you annuitize the Contract, we pay a death
benefit, or we deduct
Contract fees and expenses. The Daily Adjustment may be positive,
negative, or equal to
zero. A negative Daily Adjustment will result in a loss. In extreme
circumstances, a negative
Daily Adjustment could result in a loss beyond the protection of the
10%, 20%, or 30%
Buffer Buffer, as applicable. The maximum potential loss from a
negative Daily Adjustment
is -99%.
|
Fee Tables
4. Valuing Your
Contract
6. Expenses
Appendix B –
Daily
Adjustment
|
||
Transaction
Charges
|
Other than withdrawal charges and Daily Adjustments that may apply
to withdrawals and
other transactions under the Contract, there are no other
transaction charges.
|
Fee Tables
6. Expenses
|
||
Ongoing
Fees and
Expenses
(annual
charges)
|
The table below describes the fees and expenses that you may pay each year, depending
on the options you choose. Please refer to your Contract
specifications page for information
about the specific fees you will pay each year based on the options you
have elected.
These ongoing fees and expenses do not reflect any financial adviser
fees paid to a
Financial Professional from your Contract Value or other assets of
the Owner. If such
charges were reflected, these ongoing fees and expenses would be
higher.
[To be updated by amendment]
|
Fee Tables
6. Expenses
Appendix C –
Variable Option
Available Under
the Contract
|
||
Annual Fee
|
Minimum
|
Maximum
|
||
Base Contract(1)
|
1.26%
|
1.26%
|
||
Investment Options(2)
(Variable Option fees and expenses)
|
[XX]%
|
[XX]%
|
||
|
Optional Benefits Available for an Additional
Charge
(for a single optional benefit, if elected)
|
Not Applicable
|
Not Applicable
|
|
|
(1)
As a percentage of the Variable Option’s net asset value, plus an
amount attributable to the estimated contract
maintenance charge based on expected Contract sales.
|
|
||
|
(2)
As a percentage of the Variable Option’s average daily net assets.
|
|
|
FEES AND
EXPENSES
|
Prospectus
Location
|
||
|
Because your Contract is customizable, the choices you make affect
how much you will
pay. To help you understand the cost of owning your Contract, the
following table shows the
lowest and highest cost you could pay each year, based on current
charges. This estimate
assumes that you do not take withdrawals from the Contract, which could be subject to a
withdrawal charge, and if taken from the Index
Options could result in substantial
losses due to the application of negative Daily
Adjustments.
[To be updated by amendment]
|
|
||
|
Lowest Annual Cost:
$[XX]
|
Highest Annual Cost:
$[XX]
|
|
|
|
Assumes:
•Investment of $100,000 in the Variable
Option
•5% annual appreciation
•No additional Purchase Payments,
transfers, or withdrawals
•No financial adviser fees
|
Assumes:
•Investment of $100,000he Variable
Option
•5% annual appreciation
•No additional Purchase Payments,
transfers, or withdrawals
•No financial adviser fees
|
|
|
|
RISKS
|
|
||
Risk of Loss
|
You can lose money by investing in the Contract, including loss of
principal and previous
earnings.
|
Risk Factors
|
||
Not a
Short-Term
Investment
|
• This Contract is not a short-term investment and is not
appropriate if you need ready
access to cash.
• Considering the benefits of tax deferral and long-term income, the
Contract is generally
more beneficial to investors with a long investment time horizon.
• If, within six years after we receive a Purchase Payment, you take
a full or partial
withdrawal (including financial adviser fees that you choose to
have us pay from this
Contract), withdrawal charges will apply. A withdrawal charge will
reduce your Contract
Value or the amount of money that you actually receive. Withdrawals
may reduce or end
Contract guarantees.
• Withdrawals are subject to income taxes, and may also be subject
to a 10% additional
federal tax for amounts withdrawn before age 59 1∕2.
• Amounts invested in an Index Option must be held in the Index
Option for the full Term
before they can receive a Performance Credit. We apply a Daily
Adjustment, if before the
Term End Date, you take a full or partial withdrawal (including
financial adviser fees that
you choose to have us pay from this Contract), you execute a
Performance Lock, you
annuitize the Contract, we pay a death benefit, or we deduct
Contract fees and expenses.
• The Traditional Death Benefit may not be modified, but it will
terminate if you take
withdrawals that reduce both the Contract Value, Cash Value, and
Guaranteed Death
Benefit Value to zero. Withdrawals may reduce the Traditional Death
Benefit’s
Guaranteed Death Benefit Value by more than the value withdrawn and
could end the
Traditional Death Benefit.
|
Risk Factors
4. Valuing Your
Contract
10. Death Benefit
Appendix B –
Daily Adjustment
|
||
Risks
Associated
with
Investment
Options
|
• An investment in the Contract is subject to the risk of poor
investment performance and
can vary depending on the performance of the Variable Option and
the Index Options
available under the Contract.
• The Variable Option and each Index Option have their own unique
risks.
• You should review the Variable Option’s prospectus and
disclosures, including risk
factors, before making an investment decision.
|
Risk Factors
|
||
Insurance
Company
Risks
|
An investment in the Contract is subject to the risks related to us.
All obligations,
guarantees or benefits of the Contract are the obligations of
Allianz Life of New York and
are subject to our claims-paying ability and financial strength.
More information about
Allianz Life of New York, including our financial strength ratings,
is available upon request
by visiting allianzlife.com/new-york/about/why-allianz, or
contacting us at (800) 624-0197.
|
Risk Factors
|
|
RESTRICTIONS
|
Prospectus
Location
|
||
Investments
|
• Certain Index Options may not be available under your Contract.
• We restrict additional Purchase Payments during the Accumulation
Phase. Each Index
Year, you cannot add more than your initial amount (i.e., the total
of all Purchase
Payments received before the first Quarterly Contract Anniversary
of the first Contract
Year) without our prior approval.
• We do not accept additional Purchase Payments during the Annuity
Phase.
• We typically only allow assets to move into the Index Options on
the Index Effective Date
and on subsequent Index Anniversaries as discussed in section 3,
Purchasing the
Contract – Allocation of Purchase Payments and Contract Value
Transfers. However, if
you execute an Early Reallocation, we will move assets into an
Index Option on the
Business Day we receive your Early Reallocation request in Good
Order. The Index
Performance Strategy 6-year Term Index Options are not available as
a destination for
Early Reallocation, but they can be a source.
• You can typically transfer Index Option Value only on Term End
Dates. However, you can
transfer assets out of an Index Option before the Term End Date by
executing a
Performance Lock as discussed in section 4, Valuing Your Contract –
Performance Locks.
• We do not allow assets to move into an established Index Option
until the Term End Date.
If you request to allocate a Purchase Payment into an established
Index Option on an
Index Anniversary that is not a Term End Date, we will allocate
those assets to the same
Index Option with a new Term Start Date.
• With notice, we may make the Index Options temporarily unavailable
for a year or more if
we are unable to support the minimum Trigger Rate or Cap on that
Index Option.
– We can make all Index Options temporarily unavailable for Early
Reallocation at any
time, which means there may be times when Early Reallocation is unavailable to
you.
– We cannot make Group A Index Options temporarily
unavailable on the Index Effective
Date or an Index Anniversary.
– We can make Group B Index Options temporarily unavailable on the
Index Effective Date
or an Index Anniversary.
– We can make Group C Index Options temporarily unavailable on an
Index Anniversary
occurring on or after the sixth Index Anniversary.
(For more information on an Index Option’s temporary unavailability
group, please see
Overview of the Contract – What are the Phases of the Contract?)
Once we make an
Index Option temporarily unavailable, it may continue to be
unavailable so long as we are
unable to support its minimum Trigger Rate or Cap due to yield on
investments or the
availability or cost of hedging. However, we cannot permanently
eliminate Index Options
after we issue your Contract, and a temporarily unavailable Index
Option will become
available once we can support its minimum Trigger Rate or Cap.
Although we cannot
eliminate an Index Option from your Contract, we reserve the right
to substitute Indexes
either on a Term Start Date or during a Term.
• We reserve the right to substitute the Variable Option. We also
reserve the right to
discontinue accepting new allocations into specific Index Options
and to substitute
Indexes either on a Term Start Date or during a Term. We can also
decline a Purchase
Payment if it does not meet the requirements set out in section 3,
Purchasing the
Contract – Purchase Requirements.
|
Overview of the
Contract
Risk Factors
3. Purchasing the
Contract
4. Valuing Your
Contract
5. Variable Option
Appendix A –
Available Indexes
|
||
Optional
Benefits
|
The Contract does not offer any Optional Benefits.
|
Not Applicable
|
|
TAXES
|
Prospectus
Location
|
||
Tax
Implications
|
• Consult with a tax professional to determine the tax implications
of an investment in and
withdrawals from or payments received under the Contract.
• If you purchased the Contract through a tax-qualified plan or
individual retirement account
(IRA), you do not get any additional tax benefit under the
Contract.
• Generally, earnings under a Non-Qualified Contract are taxed at
ordinary income rates
when withdrawn, and may also be subject to a 10% additional federal
tax for amounts
withdrawn before age 59 1∕2.
• Generally, distributions from Qualified Contracts are taxed at
ordinary income tax rates
when withdrawn, and may also be subject to a 10% additional federal
tax for amounts
withdrawn before age 59 1∕2.
|
11. Taxes
|
||
|
CONFLICTS OF
INTEREST
|
|
||
Investment
Professional
Compensation
|
Your Financial Professional may receive compensation for selling
this Contract to you, in
the form of commissions, additional cash benefits (e.g., cash
bonuses), and non-cash
compensation. We and/or our wholly owned subsidiary distributor may
also make marketing
support payments to certain selling firms for marketing services and
costs associated with
Contract sales. This conflict of interest may influence your
Financial Professional to
recommend this Contract over another investment for which the
Financial Professional is
not compensated or compensated less.
|
12. Other
Information –
Distribution
|
||
Exchanges
|
Some Financial Professionals may have a financial incentive to offer
you a new contract in
place of one you already own. You should only exchange your contract
if you determine,
after comparing the features, fees, and risks of both contracts,
that it is better for you to
purchase the new contract rather than continue to own your existing
contract.
|
12. Other
Information –
Distribution
|
Currently Available
Crediting Methods,
Term Lengths and Buffers
|
Temporarily
Unavailable
Identifier
|
Currently
Available Indexes
|
Positive Index Performance
Participation Limit
|
Index Dual Precision Strategy
1-year Term with 10% Buffer
|
• Group B
|
• S&P 500® Index
• Russell 2000® Index
• Nasdaq-100® Index
• EURO STOXX 50®
|
• 5% minimum Trigger Rate
|
Index Precision Strategy
1-year Term with 10% Buffer
|
• Group C
|
• S&P 500® Index
• Russell 2000® Index
• Nasdaq-100® Index
• EURO STOXX 50®
|
• 5% minimum Trigger Rate
|
Index Performance Strategy
1-year Term with 10%, 20%, or
30% Buffer
|
• Group A for 10%
Buffer
• Group C for 20%
or 30% Buffer
|
• S&P 500® Index
• Russell 2000® Index
• Nasdaq-100® Index
• EURO STOXX 50®
|
• 3% minimum Cap for 30%
Buffer
• 4% minimum Cap for 20%
Buffer
• 5% minimum Cap for 10%
Buffer
• Can be “uncapped” (i.e., we do
not declare a Cap for that Term)
|
Index Performance Strategy
3-year Term with 10%, 20%, or
30% Buffer
|
• Group A for 10%
Buffer
• Group C for 20%
or 30% Buffer
|
• S&P 500® Index
• Russell 2000® Index
|
• 9% minimum Cap for 30%
Buffer
• 12% minimum Cap for 20%
Buffer
• 15% minimum Cap for 10%
Buffer
• Can be uncapped
• 100% minimum Participation
Rate
|
Index Performance Strategy
6-year Term with 10%, 20%, or
30% Buffer
|
• Group A for 10%
Buffer
• Group C for 20%
or 30% Buffer
|
• S&P 500® Index
• Russell 2000® Index
|
• 18% minimum Cap for 30%
Buffer
• 24% minimum Cap for 20%
Buffer
• 30% minimum Cap for 10%
Buffer
• Can be uncapped
• 100% minimum Participation
Rate
|
Number of Complete Years
Since Purchase Payment
|
Withdrawal Charge Amount
|
0
|
8%
|
1
|
7%
|
2
|
6%
|
3
|
5%
|
4
|
3%
|
5
|
1%
|
6 years or more
|
0%
|
|
Index Dual Precision Strategy, Index Precision Strategy, and
Index Performance Strategy
|
Daily Adjustment Maximum Potential Loss
|
99%
|
(as a percentage of Index Option Value, applies for distributions
from an Index Option before any Term End Date)(3)
|
|
Administrative Expenses (or contract maintenance charge)(1)
(per year)
|
$50
|
Base Contract Expenses(2)
(as a percentage of the Variable Option’s net asset value)
|
1.25%
|
(expenses that are deducted from the Variable Option's assets, including management fees,
distribution and/or service (12b-1) fees, and other expenses)
|
[XX]%
|
|
1 Year
|
3 Years
|
5 Years
|
10 Years
|
(1) If you surrender your Contract (take a full withdrawal) at the end of
the applicable time period.
|
$[XX]
|
$[XX]
|
$[XX]
|
$[XX]
|
(2) If you annuitize your Contract at the end of the applicable time
period.
|
N/A*
|
$[XX]
|
$[XX]
|
$[XX]
|
(3) If you do not surrender your Contract.
|
$[XX]
|
$[XX]
|
$[XX]
|
$[XX]
|
In recent years, the financial markets have experienced periods of
significant volatility and negative returns, contributing
to an uncertain and evolving economic environment. The performance of
the markets has been impacted by several
interrelating factors such as, but not limited to, the COVID-19
pandemic, geopolitical turmoil, rising inflation, changes in
interest rates, and actions by governmental authorities. It is not
possible to predict future performance of the markets.
Depending on your individual circumstances (e.g., your selected Index
Options and the timing of any Purchase
Payments, transfers, or withdrawals), you may experience (perhaps
significant) negative returns under the Contract. You
should consult with a Financial Professional about how recent market
conditions may impact your future investment
decisions related to the Contract, such as purchasing the Contract or
making Purchase Payments, transfers, or
withdrawals, based on your individual circumstances.
|
|
January 1, 2013 through December 31, 2023
|
|||
|
S&P 500® Index
|
Nasdaq-100® Index
|
Russell 2000® Index
|
EURO STOXX 50®
|
Returns without dividends
|
[XX]
%
|
[XX]
%
|
[XX]
%
|
[XX]
%
|
Returns with dividends
|
[XX]
%
|
[XX]
%
|
[XX]
%
|
[XX]
%
|
We will not provide advice or notify
you regarding whether you should execute a Performance Lock or Early
Reallocation or the optimal time for
doing so. We will not warn you if you execute a Performance Lock or Early
Reallocation at a sub-optimal time.
We are not responsible for any losses related to your decision whether or not to
execute a Performance Lock or Early
Reallocation.
|
We will not provide advice or notify
you regarding whether you should execute an Early Reallocation or the optimal
time for doing so. We will not warn
you if you execute an Early Reallocation at a sub-optimal time. We are not
responsible for any losses related
to your decision whether or not to execute an Early Reallocation.
|
Financial Adviser Fee
Withdrawal
|
Contract
Value
|
Traditional Death Benefit’s Guaranteed Death Benefit
|
Prior to 1st years withdrawal
|
$ 100,000
|
$ 90,000
|
$5,000 withdrawal (subject to an
|
|
|
8% withdrawal charge)
|
– [($5,000 ÷ (1 – 8%)]
|
|
Amount withdrawn
|
– $5,435
|
– [($5,435 ÷ 100,000) x 90,000]
|
|
|
= - $4,891
|
After 1st years withdrawal
|
$ 94,565
|
$ 85,109
|
|
|
|
Prior to 2nd years withdrawal
|
$ 97,000
|
$ 85,109
|
$5,000 withdrawal (not subject to a
|
|
|
withdrawal charge)
|
– $5,000
|
– [($5,000 ÷ 97,000) x 85,109]
|
|
|
= - $4,387
|
After 2nd years withdrawal
|
$ 92,000
|
$ 80,722
|
|
|
|
Prior to 3rd years withdrawal
|
$ 80,000
|
$ 80,722
|
$5,000 withdrawal (not subject to a
|
|
|
withdrawal charge)
|
– $5,000
|
– [($5,000 ÷ 80,000) x 80,722]
|
|
|
= - $5,045
|
After 3rd years withdrawal
|
$ 75,000
|
$ 75,677
|
UPON THE DEATH OF A SOLE OWNER
|
|
Action if the Contract is in the Accumulation Phase
|
Action if the Contract is in the Annuity Phase
|
• If this is an Inherited IRA Contract, the Beneficiary can either:
– continue to receive RMD payments based on the
remaining life expectancy of the deceased Owner and the
Contract Value as of the Business Day we receive a Valid
Claim, until ten years after the Owner’s death at which
time we make a lump sum payment, or
– receive a lump sum payment of the Contract Value as of
the Business Day we receive a Valid Claim.
• For all other Contracts, we pay a death benefit to the
Beneficiary unless the Beneficiary is the surviving spouse and
continues the Contract.
• If the deceased Owner was a Determining Life and the
surviving spouse Beneficiary continues the Contract:
– we increase the Contract Value to equal the Guaranteed
Death Benefit Value if greater and available, and the
death benefit ends,
– the surviving spouse becomes the new Owner,
– the Accumulation Phase continues, and
– upon the surviving spouse’s death, his or her
Beneficiary(ies) receives the Contract Value.
• If the deceased Owner was not a Determining Life, the
Traditional Death Benefit is not available and the
Beneficiary(ies) receives the Contract Value.
|
• The Beneficiary becomes the Payee. If we are still required to
make Annuity Payments under the selected Annuity Option, the
Beneficiary also becomes the new Owner.
• If the deceased was not an Annuitant, Annuity Payments to the
Payee continue. No death benefit is payable.
• If the deceased was the only surviving Annuitant, Annuity
Payments end or continue as follows.
– Annuity Option A or C, payments end when the
guaranteed period ends.
– Annuity Option B, F, or G, payments end.
– For more information on the Annuity Options, please see
section 8.
• If the deceased was an Annuitant and there is a surviving joint
Annuitant, Annuity Payments to the Payee continue during the
lifetime of the surviving joint Annuitant. No death benefit is
payable.
• For a Qualified Contract, the Annuity Payments must end ten
years after the Owner’s death.
|
FOR JOINTLY OWNED CONTRACTS: The sole primary Beneficiary is the surviving Joint Owner regardless of any
other named primary Beneficiaries. If both Joint Owners die
simultaneously, we pay the death benefit to the named
surviving primary Beneficiaries. If there are no named surviving
primary Beneficiaries, we pay the death benefit to the
named surviving contingent Beneficiaries, or equally to the estate of
the Joint Owners if there are no named surviving
contingent Beneficiaries.
|
• An assignment may be a taxable event. In addition, there are other
restrictions on changing the ownership of a
Qualified Contract and Qualified Contracts generally cannot be assigned
absolutely or on a limited basis. You should
consult with your tax adviser before
assigning this Contract.
|
• An assignment will only change the Determining Life (Lives) if it involves removing a Joint Owner due to
divorce, or replacing Joint Owners with a Trust.
|
We do not accept additional Purchase Payments if you
have an Inherited IRA, or Inherited Roth IRA Contract.
|
On your application if you select…
|
Your Index Effective Date will be either…
|
the earliest Index Effective Date
|
• your Issue Date, or
• the first Business Day of the next month if the Issue Date is the
29th, 30th, or 31st of a
month
|
the deferred Index Effective Date
|
• your first Quarterly Contract Anniversary, or
• the next Business Day if the first Quarterly Contract Anniversary
occurs on a non-Business
Day, or the first Business Day of the next month if the first
Quarterly Contract Anniversary
is the 29th, 30th, or 31st of a month
|
• In order to apply Purchase Payments we receive after the Index Effective Date to your selected Index Option(s) on
the next Index Anniversary, we must receive them before the end of the Business Day on the Index Anniversary (or
before the end of the prior
Business Day if the anniversary is a non-Business Day).
|
• The Variable Option is subject to Contract fees and expenses (e.g. contract maintenance charge) and market risk.
Assets you allocate to it may lose value, including any Purchase Payments or other assets we hold in the Variable
Option before transferring them to
your selected Index Options.
|
Variable Account Value increases when….
|
Variable Account Value decreases when….
|
• you add assets to the Variable Option by Purchase Payment
or make allocation instruction changes that transfer Index
Option Value,
• we hold assets in the Variable Option due to Purchase
Payments destined for the Index Options, a Contract Value
increase due to death, or an Index Option becoming
temporarily unavailable, or
• there is positive Variable Option performance
|
• you take assets out of the Variable Option by
withdrawal (including any financial adviser fees that you
choose to have us pay from this Contract), make allocation
instruction changes that transfer Variable Account Value, or
Early Reallocation,
• we transfer assets held in the Variable Option that are
destined for the Index Options according to allocation
instructions,
• there is negative Variable Option performance, or
• we deduct Contract fees and expenses
|
Contract fees and expenses we deduct from the
Variable Option include the M&E charge, contract maintenance charge, and
withdrawal charge as described in section 6,
Expenses. Financial adviser fees that you choose to have us pay from this
Contract are described in section 1, The
Contract.
|
Index Option Values increase when….
|
Index Option Values decrease when….
|
• you add assets to an Index Option by Purchase Payment,
make allocation instruction changes that transfer Contract
Value, or Early Reallocation,
• we transfer assets held in the Variable Option that are
destined for the Index Options according to allocation
instructions, or
• you receive a positive Performance Credit or Daily Adjustment
|
• you take assets out of an Index Option by
withdrawal (including any financial adviser fees that you
choose to have us pay from this Contract), make allocation
instruction changes that transfer Contract Value, or Early
Reallocation,
• we transfer assets out of an Index Option on a Term Start
Date because the Index Option became temporarily
unavailable,
• you receive a negative Performance Credit or Daily
Adjustment, or
• we deduct Contract fees and expenses
|
Contract fees and
expenses we deduct from the Index Options include the contract maintenance charge, and withdrawal
charge as described in section 6, Expenses.
Financial adviser fees that you choose to have us pay from this Contract are
described in section 1, The Contract.
|
• The Index Dual Precision Strategy, Index Precision Strategy, and Index Performance Strategy allow negative
Performance Credits. A negative Performance Credit means you can lose principal and previous earnings. The
maximum potential negative
Performance Credit is: -90% with a 10% Buffer, -80% with a 20% Buffer, and -70%
with a 30% Buffer.
|
• Because we calculate Index Returns only on a single date in time, you may experience negative or flat
performance even though the Index you selected for a
given Crediting Method experienced gains through
some, or most, of the Term.
|
• If an Index Performance Strategy Index Option is
“uncapped” for one Term (i.e., we do not declare a Cap for
that Term) it does not mean that we will not declare a
Cap for it on future Term Start Dates. On the next Term
Start Date we can declare a Cap for the next Term, or declare it to be
uncapped.
|
What is the asset protection?
|
|
Index Dual Precision
Strategy
|
• Protection is equal to what is available with the Index Precision
Strategy. Protection may be equal to
or less than what is available with the Index Performance Strategy
depending on the Index Option.
• Buffer absorbs 10% of loss, but you receive a negative Performance
Credit for losses greater than
10%.
• Potential for large losses in any Term.
• More sensitive to large negative market movements because small
negative market movements
within the 10% Buffer result in a positive Performance Credit.
|
What is the asset protection?
|
|
Index Precision Strategy
|
• Protection is equal to what is available with the Index Dual
Precision Strategy. Protection may be
equal to or less than what is available with the Index Performance
Strategy depending on the Index
Option.
• Buffer absorbs 10% of loss, but you receive a negative Performance
Credit for losses greater than
10%.
• Potential for large losses in any Term.
• More sensitive to large negative market movements because small
negative market movements are
absorbed by the 10% Buffer.
|
Index Performance
Strategy
|
• Index Options with a 10% Buffer provide the same protection as the
Index Dual Precision Strategy
and Index Precision Strategy. Index Options with a 20% or 30% Buffer
have more protection than
what is available with the Index Dual Precision Strategy and Index
Precision Strategy.
• Buffer absorbs 10%, 20%, or 30% of loss depending on the Index Option
you select, but you receive
a negative Performance Credit for losses greater than the Buffer.
• Potential for large losses in any Term.
• More sensitive to large negative market movements because small
negative market movements are
absorbed by the Buffer.
• In extended periods of moderate to large negative market performance,
3-year and 6-year Terms may
provide less protection than the 1-year Terms because, in part, the
Buffer is applied over a longer
period of time.
|
What is the growth opportunity?
|
|
Index Dual Precision
Strategy
|
• Growth opportunity limited by the Trigger Rates.
• May perform best in periods of small positive and/or small negative
market movements. Provides the
most return potential during periods of small negative market
movements.
• Generally less growth opportunity than the Index Precision Strategy
and Index Performance Strategy.
|
Index Precision Strategy
|
• Growth opportunity limited by the Trigger Rates.
• May perform best in periods of small positive market movements.
• Generally more growth opportunity than the Index Dual Precision
Strategy. However, less growth
opportunity than the Index Dual Precision Strategy during periods of
small negative market
movements.
• Growth opportunity may be more or less than the Index Performance
Strategy depending on Caps.
|
Index Performance
Strategy
|
• Growth opportunity limited by the Caps and/or Participation Rates. If we do not declare a Cap for an
Index Option, there is no maximum
limit on the positive Index Return for that Index Option. In
addition, you can receive more than
the positive Index Return if the Participation Rate applies
and is greater than its 100%
minimum. However, the Participation Rate cannot boost Index
Returns beyond a declared Cap.
• May perform best in a strong market.
• 1-year Term with 10% Buffer Index Options, 3-year Term with 10% or
20% Buffer Index Options, and
6-year Term with 10% or 20% Buffer Index Options have the most growth
opportunity.
• Growth opportunity for the 1-year Term with 20% or 30% Buffer may be
less than the Index Dual
Precision Strategy and Index Precision Strategy depending on Trigger
Rates and Caps.
|
What can change within a Crediting Method?
|
|
Index Dual Precision
Strategy
|
• Renewal and Early Reallocation Trigger Rates for existing Contracts
can change on each Term Start
Date.
– 1-year Term has a 5% minimum Trigger Rate.
• The 10% Buffers for the currently available Index Options cannot
change. However, if we add a new
Index Option to your Contract after the Issue Date, we establish the
Buffer for it on the date we add
the Index Option to your Contract. The minimum Buffer is 5% for a new
Index Option.
|
What can change within a Crediting Method?
|
|
Index Precision Strategy
|
• Renewal and Early Reallocation Trigger Rates for existing Contracts
can change on each Term Start
Date.
– 1-year Term has a 5% minimum Trigger Rate.
• The 10% Buffers for the currently available Index Options cannot
change. However, if we add a new
Index Option to your Contract after the Issue Date, we establish the
Buffer for it on the date we add
the Index Option to your Contract. The minimum Buffer is 5% for a new
Index Option.
|
Index Performance
Strategy
|
• Renewal and Early Reallocation Caps and/or Participation Rates for
existing Contracts can change on
each Term Start Date.
– 1-year Term with 30% Buffer has a 3% minimum Cap.
– 1-year Term with 20% Buffer has a 4% minimum Cap.
– 1-year Term with 10% Buffer has a 5% minimum Cap.
– 3-year Term with 30% Buffer has a 9% minimum Cap, and 100% minimum
Participation Rate.
– 3-year Term with 20% Buffer has a 12% minimum Cap, and 100% minimum
Participation Rate.
– 3-year Term with 10% Buffer has a 15% minimum Cap, and 100% minimum
Participation Rate.
– 6-year Term with 30% Buffer has a 18% minimum Cap, and 100% minimum
Participation Rate.
– 6-year Term with 20% Buffer has a 24% minimum Cap, and 100% minimum
Participation Rate.
– 6-year Term with 10% Buffer has a 30% minimum Cap, and 100% minimum
Participation Rate.
• The 10%, 20%, and 30% Buffers for the currently available Index
Options cannot change. However, if
we add a new Index Option to your Contract after the Issue Date, we
establish the Buffer for it on the
date we add the Index Option to your Contract. The minimum Buffer is
5% for a new Index Option.
|
• You participate in any negative Index Return in excess of the Buffer,
which reduces your Contract Value. For
example, for a 10% Buffer we absorb the first -10% of Index Return and
you could lose up to 90% of the Index Option
Value.
|
• Trigger Rates, Caps, and Participation Rates as set by us from
time-to-time may vary substantially based on market
conditions. However, in extreme market environments, it is possible that all Trigger Rates, Caps, and Participation
Rates will be reduced to their
respective minimums of 3%, 4%, 5%, 9%, 12%, 15%, 18%, 24%, 30%, or 100% as
stated in the table above. Note that
the minimum Early Reallocation Trigger Rates or Caps will be at least equal to
these minimums, but could be higher
as discussed later in this section.
|
• If your Contract is within its free look period you may be able to
take advantage of any increase in initial Trigger
Rates, Caps, and/or Participation Rates by cancelling your Contract
and purchasing a new Contract.
|
• If the initial Trigger Rates, Caps, and/or Participation Rates
available on the Index Effective Date are not acceptable
you have the following options.
|
– Cancel your Contract if you are still within the free look period. If
you took a withdrawal that was subject to a
withdrawal charge (including financial adviser fees that you choose to
have us pay from this Contract) we will refund
any previously deducted withdrawal charge upon a free look cancellation.
|
– Request to extend your Index Effective Date if you have not reached
your first Quarterly Contract Anniversary.
|
– If the free look period has expired, request a full withdrawal and
receive the Cash Value. This withdrawal is subject to
withdrawal charges, income taxes, and may also be subject to a 10%
additional federal tax for amounts withdrawn
before age 59 1∕2. If this occurs on or before the Index Effective Date, the Daily Adjustment does not apply.
If this
occurs after the Index Effective Date, you are
subject to the Daily Adjustment.
|
• Trigger Rates, Caps, and Participation Rates can be different from Index Option to Index Option. For example,
Caps for the Index Performance Strategy 1-year Terms can be different
between the S&P 500® Index and the
Nasdaq-100® Index; and Caps for the S&P 500® Index can be
different between 1-year, 3-year, and 6-year Terms on
the Index Performance Strategy. Initial, renewal, and Early Reallocation rates may also be different from
Contract-to-Contract. For example, assume that on May 1, 2026 we set Caps for the Index Performance Strategy
1-year Term with 10% Buffer using the S&P 500® Index as
follows:
|
– 13% initial rate and 12% Early Reallocation rate for new Contracts
issued in 2026,
|
– 14% renewal rate and 14% Early Reallocation rate for existing
Contracts issued in 2025, and
|
– 12% renewal rate and 13% Early Reallocation rate for existing
Contracts issued in 2024.
|
|
First Index Option
|
Second Index Option
|
||
|
Index Option Value
|
Index Option Base
|
Index Option Value
|
Index Option Base
|
Prior to partial withdrawal
|
$ 75,000
|
$ 72,000
|
$ 25,000
|
$ 22,000
|
$10,000 partial withdrawal
|
– $7,500
|
– $7,200
|
– $2,500
|
– $2,200
|
|
|
|
|
|
After partial withdrawal
|
$ 67,500
|
$ 64,800
|
$ 22,500
|
$ 19,800
|
• Amounts removed from the Index Options during the Term for partial withdrawals you take (including any
financial adviser fees that you choose to have us pay
from this Contract) and deductions we make for Contract
fees and expenses do not receive a Performance Credit
on the Term End Date. However, the remaining amount
in the Index Options is eligible for a Performance Credit on the Term
End Date.
|
• You cannot specify from which Allocation Option we deduct Contract fees and expenses; we deduct Contract fees
and expenses from each Allocation Option proportionately based on the
percentage of Contract Value in each
Allocation Option.
|
Crediting Method
and Term Length
|
If Index Value is less than it was on
the
Term Start Date
(i.e., Index Return is negative):
|
If Index Value is equal to or greater
than it was
on the Term Start Date
(i.e., Index Return is zero or positive):
|
Index Dual Precision
Strategy 1-year Term
|
Performance Credit is equal to the Trigger Rate if the
negative Index Return is less than or equal to the
10% Buffer. However, if the negative Index Return is
greater than the 10% Buffer you receive a
Performance Credit equal to the negative Index
Return in excess of the 10% Buffer.
If the Index Return is…
• -8%, the Performance Credit is equal to the Trigger
Rate set on the Term Start Date.
• -12%, the Performance Credit is -2%.
|
Performance Credit is equal to the Trigger Rate set
on the Term Start Date
|
Index Precision
Strategy 1-year Term
|
Performance Credit is equal to the negative Index
Return in excess of the 10% Buffer.
If the Index Return is…
• -8%, the Performance Credit is zero.
• -12%, the Performance Credit is -2%.
|
Performance Credit is equal to the Trigger Rate set
on the Term Start Date
|
Index Performance
Strategy 1-year Term
|
Performance Credit is equal to the negative Index
Return in excess of the 10%, 20%, or 30% Buffer.
Assume you select a 1-year Term Index Option with
10% Buffer. If the Index Return for the year is…
• -8%, the Performance Credit is zero.
• -12%, the Performance Credit is -2%.
Instead assume you select a
1-year Term Index
Option with 20% Buffer, and the Index Return for
the Term is…
• -19%, the Performance Credit is 0%.
• -24%, the Performance Credit is -4%.
Instead assume you select a
1-year Term Index
Option with 30% Buffer, and the Index Return for
the Term is…
• -29%, the Performance Credit is 0%.
• -36%, the Performance Credit is -6%.
|
Performance Credit is equal to the Index Return up
to any Cap set on the Term Start Date
Assume the Cap for the 1-year Term is 8%. If the
Index Return for the year is…
• 0%, the Performance Credit is zero.
• 6%, the Performance Credit is 6%.
• 12%, the Performance Credit is 8%. If instead the
1-year Term were uncapped, the
Performance
Credit is 12%.
|
Crediting Method
and Term Length
|
If Index Value is less than it was on
the
Term Start Date
(i.e., Index Return is negative):
|
If Index Value is equal to or greater
than it was
on the Term Start Date
(i.e., Index Return is zero or positive):
|
Index Performance
Strategy 3-year Term
|
Performance Credit is equal to the negative Index
Return in excess of the 10%, 20%, or 30% Buffer.
Assume you select a 3-year Term Index Option with
10% Buffer. If the Index Return for the Term is…
• -19%, the Performance Credit is -9%.
• -24%, the Performance Credit is -14%.
Instead assume you select a
3-year Term Index
Option with 20% Buffer, and the Index Return for
the Term is…
• -19%, the Performance Credit is 0%.
• -24%, the Performance Credit is -4%.
Instead assume you select a
3-year Term Index
Option with 30% Buffer, and the Index Return for
the Term is…
• -29%, the Performance Credit is 0%.
• -36%, the Performance Credit is -6%.
|
Performance Credit is equal to the Index Return
multiplied by the Participation Rate, up to any Cap
set on the Term Start Date
Assume the Participation Rate is 100% and the Cap
is 80%. If the Index Return for the Term is…
• 0%, the Performance Credit is zero.
• 65%, the Performance Credit is 65%.
• 90%, the Performance Credit is 80%.
If instead the Participation Rate is
110% and the
3-year Term were uncapped, and the Index Return
for the Term is…
• 0%, the Performance Credit is zero.
• 65%, the Performance Credit is 71.5%.
• 90%, the Performance Credit is 99%.
|
Index Performance
Strategy 6-year Term
|
Performance Credit is equal to the negative Index
Return in excess of the 10%, 20%, or 30% Buffer.
If the Index Return for the Term is…
• -19%, the Performance Credit is -9%.
• -24%, the Performance Credit is -14%.
Instead assume you select a
6-year Term Index
Option with 20% Buffer, and the Index Return for
the Term is…
• -19%, the Performance Credit is 0%.
• -24%, the Performance Credit is -4%.
Instead assume you select a
3-year Term Index
Option with 30% Buffer, and the Index Return for
the Term is…
• -29%, the Performance Credit is 0%.
• -36%, the Performance Credit is -6%.
|
Performance Credit is equal to the Index Return
multiplied by the Participation Rate, up to any Cap
set on the Term Start Date
Assume the Participation Rate is 100% and the Cap
is 85%. If the Index Return for the Term is…
• 0%, the Performance Credit is zero.
• 65%, the Performance Credit is 65%.
• 90%, the Performance Credit is 85%.
If instead the Participation Rate is
110% and the
6-year Term were uncapped, and the Index Return
for the Term is…
• 0%, the Performance Credit is zero.
• 65%, the Performance Credit is 71.5%.
• 90%, the Performance Credit is 99%.
|
We will not provide advice or notify
you regarding whether you should execute a Performance Lock or the optimal
time for doing so. We will not warn
you if you execute a Performance Lock at a sub-optimal time. We are not
responsible for any losses related
to your decision whether or not to execute a Performance Lock.
|
We will not provide advice or notify
you regarding whether you should execute an Early Reallocation or the optimal
time for doing so. We will not warn
you if you execute an Early Reallocation at a sub-optimal time. We are not
responsible for any losses related
to your decision whether or not to execute an Early Reallocation.
|
Currently, the Contract does not offer any Variable Option other than
the AZL Government Money Market Fund. If we
were to offer additional Variable Option(s) in the future they would be
subject to the following provisions.
|
This Contract is not designed for professional market timing
organizations, or other persons using programmed, large, or
frequent transfers, and we may restrict excessive or inappropriate
transfer activity.
|
|
Base Contract Expenses
(as a percentage of the Variable Option’s net asset value)
|
Mortality and Expense Risk (M&E) Charge(1)
|
1.25%
|
Calculating a Withdrawal Charge
|
Example
|
|
For purposes of calculating any withdrawal charge, we withdraw
Purchase Payments on a “first-in-first-out” (FIFO) basis and we
process withdrawal requests as follows.
|
You make an initial Purchase Payment of $55,000 and make
another Purchase Payment in the first month of the second
Contract Year of $45,000. In the third month of the third
Contract Year, your Contract Value is $110,000 and you
request a $70,000 withdrawal. We withdraw money and
compute the withdrawal charge as follows.
|
|
1. First, we withdraw from Purchase Payments that we have had
for six or more complete years, which is your Contract’s
withdrawal charge period. This withdrawal is not subject to a
withdrawal charge and it reduces the Withdrawal Charge Basis
dollar for dollar.
|
1. Purchase Payments beyond the withdrawal charge
period. All payments are still within the withdrawal charge
period, so this does not apply.
|
|
2. Amounts available as a Penalty-Free Withdrawal. This includes
partial withdrawals you take during the Accumulation Phase
under the free withdrawal privilege or waiver of withdrawal
charge benefit, and RMD payments you take under our
minimum distribution program. Penalty-Free Withdrawals are
not subject to a withdrawal charge, but they reduce the
Withdrawal Charge Basis dollar for dollar, and are withdrawn
from Purchase Payments on a FIFO basis.
|
2. Amounts available as a Penalty-Free Withdrawal. You
did not take any other withdrawals this year, so the entire
free withdrawal privilege (10% of your total Purchase
Payments, or $10,000) is available to you without incurring a
withdrawal charge. We also deduct this $10,000 from the
first Purchase Payment.
|
|
3. Next, on a FIFO basis, we withdraw from Purchase Payments
within your Contract’s withdrawal charge period and assess a
withdrawal charge. Withdrawing payments on a FIFO basis
may help reduce the total withdrawal charge because the
charge declines over time. We determine your total withdrawal
charge by multiplying each payment by its applicable
withdrawal charge percentage and then totaling the charges.
These withdrawals reduce the Withdrawal Charge Basis.
The withdrawal charge as a percentage of each Purchase
Payment withdrawn is as follows.
|
3. Purchase Payments within the withdrawal charge period
on a FIFO basis. The total amount we withdraw from the
first Purchase Payment is $45,000, which is subject to a 6%
withdrawal charge, and you receive $42,300. We determine
this amount as follows:
(amount withdrawn) x (1 – withdrawal charge) = the
amount you receive, or:
$45,000 x 0.94 = $42,300
The total amount we withdraw from the second Purchase
Payment is $19,032, which is subject to a 7% withdrawal
charge, and you receive $17,700. We determine this amount
as follows:
(amount withdrawn) x (1 – withdrawal charge) = the
amount you receive, or:
$19,032 x 0.93 = $17,700
|
|
Number of Complete
Years Since
Purchase Payment
|
Withdrawal Charge
Amount
|
|
0
1
2
3
4
5
6 years or more
|
8%
7%
6%
5%
3%
1%
0%
|
|
Calculating a Withdrawal Charge
|
Example
|
|
4. Finally, we withdraw any Contract earnings. This withdrawal is
not subject to a withdrawal charge and it does not reduce the
Withdrawal Charge Basis.
|
4. Contract earnings. We already withdrew your requested
amount, so this does not apply.
In total we withdrew $74,032 from your Contract, of
which you received $70,000 and paid a withdrawal
charge of $4,032. We also reduced the 1st Purchase
Payment from $55,000 to $0, and your 2nd Purchase
Payment from $45,000 to $25,968 ($45,000 – $19,032).
Please note that this example may
differ from your
actual results due to rounding.
|
• Upon a full withdrawal, the free withdrawal privilege is not available to you, and we apply a withdrawal charge
against Purchase Payments that are still within the withdrawal charge
period, including amounts previously
withdrawn under the free withdrawal privilege. On a full withdrawal, your Withdrawal Charge Basis may be
greater than your Contract Value because the following
reduce your Contract Value, but do not reduce your
Withdrawal Charge Basis:
|
– deductions we make for Contract fees and expenses other than the withdrawal charge, and/or
|
– poor performance.
|
This also means that upon a full
withdrawal you may not receive any money.
|
• Withdrawals (including any financial adviser fees that you choose to have us pay from this Contract) are subject to
ordinary income taxes, and may also be subject to a 10%
additional federal tax for amounts withdrawn before
age 59 1∕2. The amount of Contract Value available for withdrawal is also affected by the Daily Adjustment
(which can be negative) unless taken
on a Term End Date. If you have Index Options with different Term End
Dates, there may be no time you can
take a withdrawal without application of at least one Daily Adjustment.
Please consult with your Financial
Professional before requesting us to pay financial adviser fees from this
Contract rather than from other
assets you may have.
|
• For tax purposes, and in most instances, withdrawals from Non-Qualified Contracts are considered to come from
earnings first, not Purchase Payments.
|
|
Index Dual Precision Strategy, Index Precision Strategy, and
Index Performance Strategy
|
Daily Adjustment Maximum Potential Loss
|
99%
|
(as a percentage of Index Option Value, applies for distributions
from an Index Option before any Term End Date)
|
|
• Withdrawals are subject to a withdrawal charge, income taxes, and may also be subject to a 10% additional federal
tax for amounts withdrawn before age 59 1∕2. The amount of Contract Value available for
withdrawal may also be
affected by the Daily Adjustment (which can be negative). Please consult with your Financial Professional
before
requesting us to pay financial
adviser fees from this Contract rather than from other assets you may have.
|
• Joint Owners: We send one check payable to both Joint Owners and we tax
report to each Joint Owner individually.
Tax reporting each Joint Owner
individually can create a discrepancy in taxation if only one Joint Owner is under
age 59 1∕2 because that Joint Owner may be subject to the 10% additional federal tax.
|
• We may be required to provide information about you or your Contract to government regulators. We may also be
required to stop Contract disbursements and thereby refuse any transfer
requests, and refuse to pay any withdrawals
(including a full withdrawal), or death benefits until we receive
instructions from the appropriate regulator. If,
pursuant to SEC rules, the AZL Government Money Market Fund suspends
payment of redemption proceeds in
connection with a fund liquidation, we will delay payment of any
transfer, full or partial withdrawal, or death benefit
from the AZL Government Money Market Fund subaccount until the fund is
liquidated.
|
The free withdrawal privilege is not available upon a
full withdrawal.
|
• You should consult a tax adviser before purchasing a Qualified Contract that is subject to RMD payments.
|
• The minimum distribution program is not available if you have a Qualified Contract purchased through a
qualified plan.
|
• If you do not choose an Annuity Option before the Annuity Date, we make Annuity Payments to the Payee
under Annuity Option C with ten years of guaranteed
monthly payments.
|
• For Owners younger than age 59 1∕2, Annuity
Payments may be subject to a 10% additional federal tax.
|
• For a Qualified Contract, the Annuity Payments must end ten years after the Owner’s death.
|
• If Annuity Payments would be less than $100, we reserve the right to require you to take a full withdrawal and
your Contract will then terminate. We do not assess a
withdrawal charge on this full withdrawal.
|
• If on the maximum Annuity Date your Contract Value is greater than zero, you must annuitize the Contract.
We notify you of your available options in writing 60 days in advance. If on your maximum Annuity Date you have
not selected an Annuity Option, we
make payments under Annuity Option C with ten years of guaranteed monthly
payments. Upon annuitization you no longer have Contract Value or a death benefit, and you cannot receive any
other periodic withdrawals or payments other than Annuity Payments.
|
Standard Benefits (No Additional Charge)
|
||
Name of
Benefit
|
Purpose
|
Brief Description of
Restrictions/Limitations
|
Free
Withdrawal
Privilege
|
Allows you to withdraw up to 10% of your total
Purchase Payments each Contract Year without
incurring a withdrawal charge.
|
• Only available during the Accumulation Phase.
• Not available upon a full withdrawal.
• Unused free withdrawal amounts not available in
future years.
• Program withdrawals may be subject to negative
Daily Adjustments.
• Program withdrawals are subject to income taxes,
and may also be subject to a 10% additional
federal tax for amounts withdrawn before age
59 1∕2.
|
Minimum
Distribution
Program
|
Allows you to automatically take withdrawals to
satisfy the minimum distribution requirements (RMD)
imposed by the Internal Revenue Code.
|
• Only available during the Accumulation Phase.
• Only available to IRA or SEP IRA Contracts.
• Generally required for Inherited IRA and Inherited
Roth IRA Contracts.
• Program withdrawals count against free withdrawal
privilege.
• Program withdrawals may be subject to negative
Daily Adjustments.
• Program withdrawals are subject to income taxes.
• Program withdrawals may be monthly, quarterly,
semi-annual or annual, unless you have less than
$25,000 in Contract Value, in which case only
annual payments are available.
• We reserve the right to discontinue or modify the
program subject to the requirements of law.
|
Financial
Adviser
Fees
|
If you have a financial adviser and want to pay their
financial adviser fees from this Contract, you can
instruct us to withdraw the fee from your Contract
and pay it to your Financial Professional or Financial
Professional’s firm as instructed.
|
• Only available during the Accumulation Phase.
• Financial adviser fees are in addition to the
Contract’s fees and expenses.
• Deductions for financial adviser fees are treated as
withdrawals under the Contract.
• Program withdrawals count against free withdrawal
privilege.
• Program withdrawals may be subject to negative
Daily Adjustments.
• Program withdrawals are subject to withdrawal
charges, income taxes, and may also be subject to
a 10% additional federal tax for amounts
withdrawn before age 59 1∕2.
• We reserve the right to discontinue or modify the
program.
• See section 1 for an example of how deduction of
financial adviser fees impact the Contract.
|
Standard Benefits (No Additional Charge)
|
||
Name of
Benefit
|
Purpose
|
Brief Description of
Restrictions/Limitations
|
Waiver of
Withdrawal
Charge
Benefit
|
Waives withdrawal charges if you become confined
to a skilled nursing facility or hospital.
|
• Only available during the Accumulation Phase.
• Confinement must begin after the first Contract
Year, be for at least 90 consecutive days, and
requires proof of stay.
• Requires physician certification.
• Not available if any Owner was confined on the
Issue Date.
• Program withdrawals count against free withdrawal
privilege.
• Program withdrawals may be subject to negative
Daily Adjustments.
• Program withdrawals are not subject to withdrawal
charges, but are subject to income taxes, and may
also be subject to a 10% additional federal tax for
amounts withdrawn before age 59 1∕2.
• State variations may apply.
|
Traditional
Death Benefit
|
Provides a death benefit equal to the greater of the
Contract Value, or Guaranteed Death Benefit Value.
The Guaranteed Death Benefit Value is total
Purchase Payments adjusted for withdrawals.
An example of the death benefit provided by the
Traditional Death Benefit is included in section 10,
Death Benefit.
An example of how deduction of financial adviser
fees impact the death benefit is included in section 1.
|
• Benefit only available during the Accumulation
Phase.
• Withdrawals, including any negative Daily
Adjustments, may significantly reduce the benefit
as indicated in section 1, Financial Adviser Fee
Deduction Example.
• Restrictions on Purchase Payments may limit the
benefit.
• Annuitizing the Contract will end the benefit.
|
Standard Benefits (No Additional Charge)
|
||
Name of
Benefit
|
Purpose
|
Brief Description of
Restrictions/Limitations
|
Performance
Lock
|
Allows you to capture the current Index Option Value
during the Term for an Index Option. Can help
eliminate doubt about future Index performance and
possibly limit the impact of negative performance.
Can allow you to transfer out of an Index Option
before the Term End Date.
A Performance Lock example is included in section
4, Valuing Your Contract — Performance Locks.
|
• Available during the Accumulation Phase.
• Performance Locks must be executed before the
Term End Date.
• If a Performance Lock is executed, the locked
Index Option will no longer participate in Index
performance (positive or negative) for the
remainder of the Term, and will not receive a
Performance Credit on the Term End Date.
• You will not know your locked Index Option Value
in advance.
• The locked Index Option Value will reflect a Daily
Adjustment.
• If a Performance Lock is executed when the Daily
Adjustment has declined, it will lock in any loss.
• A Performance Lock can be executed only once
each Term for each Index Option.
• Cannot execute a Performance Lock for only a
portion of the Index Option Value.
• Deductions (e.g. withdrawals, fees) decrease the
locked Index Option Value.
• Cannot transfer locked Index Option Value until the
next Index Anniversary that occurs on or
immediately after the Lock Date unless you
execute an Early Reallocation.
• We will not provide advice or notify you
regarding whether you should execute a
Performance Lock or the optimal time for doing
so.
• We will not warn you if you execute a
Performance Lock at a sub-optimal time.
• We are not responsible for any losses related
to your decision whether or not to execute a
Performance Lock.
|
Early Reallocation
|
Allows you to transfer from the Variable Option
and/or locked Index Options on days other than an
Index Anniversary.
An Early Reallocation Request example is included
in section 4, Valuing Your Contract — Early
Reallocations.
|
• Available during the Accumulation Phase.
• Early Reallocation requests are not accepted
before the Index Effective Date, or within 14
calendar days before an Index Anniversary, and
are limited to two Early Reallocation requests each
Index Year.
• All Index Options can be temporarily unavailable
for Early Reallocation at any time, which means
there may be times when Early
Reallocation is
unavailable to you.
• Index Performance Strategy 6-year Term Index
Options and the Variable Option are not available
as destinations for Early Reallocation, but they can
be a source.
• We will not provide advice or notify you
regarding whether you should execute an Early
Reallocation or the optimal time for doing so.
• We will not warn you if you execute an Early
Reallocation at a sub-optimal time.
• We are not responsible for any losses related
to your decision whether or not to execute an
Early Reallocation.
|
We base the Guaranteed Death Benefit Value on the first death of a
Determining Life (or Lives). This means that upon
the death of an Owner (or Annuitant if the Owner is a non-individual),
if a surviving spouse continues the Contract, the
Guaranteed Death Benefit Value is no
longer available. Also, if you and the Determining Life (Lives) are different
individuals and you die first, the
Guaranteed Death Benefit Value is not available to your Beneficiary(ies).
|
Type of Contract
|
Persons and Entities that can own the Contract
|
IRA
|
Must have the same individual as Owner and Annuitant.
|
Roth IRA
|
Must have the same individual as Owner and Annuitant.
|
SEP IRA
|
Must have the same individual as Owner and Annuitant.
|
Certain Code Section 401 Plans
|
A qualified retirement plan is the Owner and the Annuitant must be an individual who is a
participant in the plan. If the qualified retirement plan is a defined benefit plan, the
individual
must be the only participant in the plan.
We may determine which types of qualified retirement plans are eligible to purchase this
Contract.
|
Inherited IRA and Inherited Roth IRA
|
Must have the same individual as Owner and Annuitant. The deceased owner of the
previously held tax-qualified arrangement will also be listed in the titling of the Contract.
|
Name(1)
|
Title
|
Allocation
Percentages
|
Jasmine M. Jirele
|
Chair and Chief
Executive Officer
|
5.00%
|
William E. Gaumond
|
Chief Financial Officer
and Treasurer
|
5.00%
|
Compensation Element
|
Description
|
Objective
|
Base Salary
|
Fixed rate of pay that compensates employees for fulfilling their
basic job responsibilities. For NEOs, increases are generally
provided in the case of a significant increase in responsibilities
or a significant discrepancy versus the market.
|
Attract and retain high-caliber
leadership.
|
Annual Incentive Plan
|
Incentive compensation that promotes and rewards the
achievement of annual performance objectives through awards
under the Allianz Life Annual Incentive Plan (“AIP”).
|
• Link compensation to annual
performance results.
• Attract and motivate
high-caliber leadership.
• Align the interests of NEOs
and our stockholder.
|
Performance-Based Equity
Incentives
|
Incentive compensation through restricted stock unit awards
made under the Allianz Equity Incentive Plan (“AEI”) that
promotes and rewards the achievement of long term
performance objectives.
|
• Retain high-caliber leadership
with multi-year vesting.
• Align the interests of NEOs
and our stockholder.
|
Severance Arrangements
|
Severance payments to employees, including NEOs, under
certain company-initiated termination events.
|
Compensate employees for
situations where the employee’s
employment is involuntarily
terminated in a qualifying
termination of employment.
|
Perquisites-Benefits
|
Perquisites provided to our NEOs include employer matching
contributions to the NEOs’ accounts in the 401(k) plan and may
also include the payment of life insurance premiums, relocation
reimbursements, and reimbursements for financial planning, tax
preparation services, and spousal travel expenses.
|
Provide market competitive total
compensation package.
|
Name and Principal
Position
(a)
|
Year
(b)
|
NY Allocation %
|
Salary
(c)
|
Bonus
(d)
|
Stock
Awards
(e)(2)
|
Non-Equity
Incentive Plan Compensation
(g)
|
All Other
Compensation
(i)(3)
|
Total
(j)
|
Jasmine M. Jirele(1)
Chair and Chief Executive
Officer
|
2022
|
5.00%
|
$37,500
|
$10,000
|
$67,444
|
$44,963
|
$1,191
|
$161,097
|
2021
|
2.50%
|
$14,049
|
$9,750
|
$26,708
|
$17,805
|
$563
|
$68,874
|
|
William E. Gaumond
Chief Financial Officer and
Treasurer
|
2022
|
5.00%
|
$25,261
|
$0
|
$47,125
|
$21,417
|
$1,242
|
$95,045
|
2021
|
5.00%
|
$23,795
|
$15,000
|
$38,548
|
$25,699
|
$1,122
|
$104,163
|
|
2020
|
5.00%
|
$23,444
|
$0
|
$24,112
|
$16,075
|
$1,315
|
$64,946
|
Name
|
Year
|
Spousal
Travel
|
Milestone/
Anniversary/
Recognition(4)
|
Life
Insurance
Premiums
|
Employer
Match to
401(k) Plan
|
ASAAP
Contribution(5)
|
Total
|
Jasmine M. Jirele
|
2022
|
--
|
$13
|
$34
|
$1,025
|
$119
|
$1,191
|
2021
|
--
|
$9
|
$10
|
$488
|
$56
|
$563
|
|
William E. Gaumond
|
2022
|
--
|
$64
|
$35
|
$1,025
|
$119
|
$1,242
|
2021
|
--
|
--
|
$34
|
$975
|
$113
|
$1,122
|
|
2020
|
$213
|
--
|
$33
|
$975
|
$94
|
$1,315
|
Name
(a)
|
Grant Date
(b)
|
Estimated Future Payouts Under
Non-Equity
Incentive Plan Awards(1)
|
Estimated Future Payouts Under Equity
Incentive
Plan Awards(2,3)
|
||||
Threshold ($)
(c)
|
Target ($)
(d)
|
Maximum ($)
(e)
|
Threshold ($)
(f)
|
Target ($)
(g)
|
Maximum ($)
(h)
|
||
Jasmine M. Jirele
|
3/3/2023
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$56,250
|
$253,125
|
AIP Award
|
|
$0
|
$37,500
|
$56,250
|
|
|
|
William E. Gaumond
|
3/3/2023
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$27,289
|
$122,802
|
AIP Award
|
|
$0
|
$18,193
|
$27,289
|
|
|
|
Name
(a)
|
RSUs
|
|
Number of RSUs
That Have Not
Vested
(g)(1,2)
|
Market Value of
RSUs That Have
Not Vested
(h)(3)
|
|
Jasmine M. Jirele
|
|
|
|
73.350
|
$15,737
|
|
94.300
|
$20,231
|
|
120.350
|
$25,820
|
|
309.750
|
$66,454
|
William E. Gaumond
|
|
|
|
76.900
|
$16,498
|
|
97.400
|
$20,896
|
|
73.150
|
$15,694
|
|
223.550
|
$47,960
|
Name
|
Stock Awards
|
|
Number of
Shares
Acquired
on Vesting (#)
|
Value Realized
on Vesting ($)(1)
|
|
Jasmine M. Jirele
|
-
|
-
|
William E. Gaumond
|
102
|
$22,905
|
NEOs
|
Lump Sum Payment
|
Jasmine M. Jirele
|
$56,250
|
William E. Gaumond
|
$38,625
|
Name
(a)
|
Fees Earned or
Paid in Cash
($)(1)
(b)
|
Total
($)
(h)
|
Jasmine M. Jirele(2)
Chair and Chief Executive
Officer
|
N/A
|
N/A
|
William E. Gaumond(2)
Chief Financial Officer and
Treasurer
|
N/A
|
N/A
|
Eric J. Thomes(2)
President
|
N/A
|
N/A
|
Steven J. Thiel(2)
Vice President, Appointed
Actuary
|
N/A
|
N/A
|
Jesse J. Kling(2)
Vice President, Appointed
Actuary
|
N/A
|
N/A
|
Lorraine Lods(2)
Non-Independent Director
|
N/A
|
N/A
|
Ronald M. Clark
Independent Director
|
$30,000
|
$30,000
|
Martha Clark Goss
Independent Director
|
$45,000
|
$45,000
|
Gary A. Smith
Non-Independent Director
|
$30,000
|
$30,000
|
Kevin E. Walker
Independent Director
|
$30,000
|
$30,000
|
Investment Objectives
|
Variable Option and
Adviser/Subadviser
|
Current
Expenses
|
Average Annual Total Returns
(as of December 31, 2023)
|
||
1 Year
|
5 Years
|
10 Years
|
|||
Current income consistent with
stability of principal
|
AZL®
Government Money
Market Fund(1)
Adviser: Allianz Investment
Management LLC
Subadviser: BlackRock
Advisors, LLC
|
[XX]%
|
[XX]%
|
[XX]%
|
[XX]%
|
To send applications, and/or a check for an additional Purchase Payment,
or for general customer service, please mail to the appropriate address as follows:
|
REGULAR MAIL
|
Allianz Life Insurance Company of New York
P.O. Box 59060
Minneapolis MN 55459-0060
|
|
OVERNIGHT, CERTIFIED, OR REGISTERED MAIL
|
Allianz Life Insurance Company of New York
5701 Golden Hills Drive
Minneapolis MN 55416-1297
|
Checks sent to the wrong address for applications or
additional Purchase Payments are forwarded to the 5701
Golden Hills Drive address listed above, which may
delay processing.
|
Securities and Exchange Commission Registration Fee
|
$ *
|
--------------
|
|
Estimated Printing and Filing Costs:
|
$ *
|
--------------
|
|
Estimated Accounting Fees:
|
$ *
|
---------------
|
|
Estimated Legal Fees:
|
$ *
|
---------------
|
|
Estimated Miscellaneous Fees:
|
N/A
|
---------------
|
1. (a)
|
Principal Underwriter Agreement by and between Preferred Life Insurance Company of New York
on behalf of Preferred Life Variable Account C and NALAC Financial Plans, Inc. incorporated by reference as exhibit EX-99.B3.a. from Registrant’s Pre-Effective Amendment No. 1 to Form N-4 (File Nos. 333-19699 and 811-05716) electronically
filed on May 12, 1997. Preferred Life Insurance Company of New York is the predecessor to Allianz Life Insurance Company of New York. Preferred Life Variable Account C is the predecessor to Allianz Life of NY Variable Account C. NALAC
Financial Plans, Inc., is the predecessor to USAllianz Investor Services, LLC, which is the predecessor to Allianz Life Financial Services, LLC.
|
(b) | Broker-Dealer Agreement (amended and restated) between Allianz Life Insurance Company of New York and Allianz Life Financial Services, LLC, dated June 1, 2010 incorporated by reference as exhibit EX- 99.B3.b. from Registrant’s Post-Effective Amendment No. 21 to Form N-4 (File Nos. 333-143195 and 811-05716) electronically filed on October 21, 2010. |
(c)
|
The current specimen of the selling agreement between Allianz Life
Financial Services, LLC, the principal underwriter for the Contracts, and retail brokers which offer and sell the Contracts to the public is incorporated by reference as exhibit EX-99.B3.b from the Initial Registration Statement to Allianz
Life Variable Account B’s Form N-4 (File Nos.333-134267 and 811-05618) electronically filed on May 19, 2006. The underwriter has executed versions of the agreement with approximately 2,100 retail brokers.
|
2.
|
Not applicable
|
3. (a)
|
Articles of Incorporation, as amended and restated March
9, 2011, of Allianz Life Insurance Company of New York, filed on December 19, 2013 as Exhibit 3(a) to Registrant's initial registration on Form S-1 (File No. 333-192948), is incorporated by reference.
|
|
5.** |
Opinion re Legality, to be filed by amendment.
|
8.
|
Opinion re Tax Matters - not applicable
|
9.
|
Not applicable
|
10.
|
Material Contracts - not applicable
|
11.
|
Not applicable
|
12.
|
Not applicable
|
15.
|
Not applicable
|
16.
|
Not applicable
|
21. |
Not applicable.
|
25. |
Not applicable
|
26. |
Not applicable
|
(1)
|
To file, during any period in which offers or sales are being made, a post-effective amendment to this registration statement:
|
(i)
|
To include any prospectus required by section 10(a)(3) of the Securities Act of 1933;
|
(ii)
|
To reflect in the prospectus any facts or events arising after the effective date of the registration statement (or the most recent post-effective amendment
thereof) which, individually or in the aggregate, represent a fundamental change in the information set forth in the registration statement. Notwithstanding the foregoing, any increase or decrease in volume of securities offered (if the total
dollar value of securities offered would not exceed that which was registered) and any deviation from the low or high end of the estimated maximum offering range may be reflected in the form of prospectus filed with the Commission pursuant to
Rule 424(b) if, in the aggregate, the changes in volume and price represent no more than a 20% change in the maximum aggregate offering price set forth in the "Calculation of Registration Fee" table in the effective registration statement.
|
(iii)
|
To include any material information with respect to the plan of distribution not previously disclosed in the registration statement or any material change to
such information in the registration statement.
|
(2)
|
That, for the purpose of determining any liability under the Securities Act of 1933, each such post-effective amendment shall be deemed to be a new registration
statement relating to the securities offered therein, and the offering of such securities at that time shall be deemed to be the initial bona fide offering thereof.
|
(3)
|
To remove from registration by means of a post-effective amendment any of the securities being registered which remain unsold at the termination of the offering.
|
(4)
|
That, for the purpose of determining liability under the Securities Act of 1933 to any purchaser, each prospectus filed pursuant to Rule 424(b) as part of a
registration statement relating to an offering, other than registration statements relying on Rule 430B or other than prospectuses filed in reliance on Rule 430A, shall be deemed to be part of and included in the registration statement as of
the date it is first used after effectiveness. Provided, however, that no statement made in a registration statement or prospectus that is part of the registration statement or made in a document incorporated or deemed incorporated by
reference into the registration statement or prospectus that is part of the registration statement will, as to a purchaser with a time of contract of sale prior to such first use, supersede or modify any statement that was made in the
registration statement or prospectus that was part of the registration statement or made in any such document immediately prior to such date of first use.
|
(5)
|
That, for the purpose of determining liability of the registrant under the Securities Act of 1933 to any purchaser in the initial distribution of the securities:
The undersigned registrant undertakes that in a primary offering of securities of the undersigned registrant pursuant to this registration statement, regardless of the underwriting method used to sell the securities to the purchaser, if the
securities are offered or sold to such purchaser by means of any of the following communications, the undersigned registrant will be a seller to the purchaser and will be considered to offer or sell such securities to such purchaser:
|
(i)
|
Any preliminary prospectus or prospectus of the undersigned registrant relating to the offering required to be filed pursuant to Rule 424;
|
(ii)
|
Any free writing prospectus relating to the offering prepared by or on behalf of the undersigned registrant or used or referred to by the undersigned registrant;
|
(iii)
|
The portion of any other free writing prospectus relating to the offering containing material information about the undersigned registrant or its securities
provided by or on behalf of the undersigned registrant; and
|
(iv)
|
Any other communication that is an offer in the offering made by the undersigned registrant to the purchaser.
|
(6)
|
Insofar as indemnification for liabilities arising under the Securities Act of 1933 may be permitted to directors, officers and controlling persons of the
Insurance Company pursuant to the foregoing provisions, or otherwise, the Insurance Company has been advised that in the opinion of the Securities and Exchange Commission such indemnification is against public policy as expressed in the Act
and, is therefore, unenforceable. In the event that a claim for indemnification against such liabilities (other than the payment by the Insurance Company of expenses incurred or paid by a director, officer or controlling person of the
Insurance Company in the successful defense of any action, suit or proceeding) is asserted by such director, officer or controlling person in connection with the securities being registered, the Insurance Company will, unless in the opinion
of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the Act and will be governed by the
final adjudication of such issue.
|
Signature
|
Title
|
Jasmine M. Jirele*
|
Director, Board Chair and Chief Executive Officer
|
Eric J. Thomes*
|
Director and President
|
Gary A. Smith*
|
Director
|
Martha Clark Goss*
|
Director
|
Ronald M. Clark*
|
Director
|
William E. Gaumond*
|
Director, Chief Financial Officer and Treasurer
|
(principal accounting officer)
|
|
Jesse J. Kling*
|
Director, Vice President and Appointed Actuary
|
Lorraine Lods *
|
Director
|
Kevin E. Walker*
|
Director
|
* |
By Power of Attorney, filed as Exhibit 24(c) to this Registration Statement.
|
Exhibit
|
Description of Exhibit
|
|
4(a)
|
Individual Flexible Purchase Payment Variable and Index-Linked Deferred Annuity Contract, L40538-01-NY
|
|
4(b)
|
Contract Schedule Pages, S40875-01-NY and S40876-01-NY
|
|
4(c)
|
Application for Individual Annuity Contract, INYP-APP_0524
|
|
4(d)
|
Non-Qualified Annuity Stretch Endorsement, TE-NQ2023-NY
|
|
24(c)
|
Powers of Attorney
|
|
99(a)
|
Daily Adjustment Calculation
|
|
107
|
Filing Fees Table
|
Contract Schedule 3
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
•
|
The Business Day we process your request for a Full Withdrawal.
|
•
|
The Business Day before the Annuity Date.
|
•
|
The Business Day that the Service Center receives a Valid Claim from all the Beneficiaries upon the death of an Owner (or Annuitant if
the Owner is a non-individual), unless this contract is continued by the deceased Owner’s Spouse.
|
•
|
Under Annuity Option A, at the end of the guaranteed period.
|
•
|
Under Annuity Option B, the death of the Annuitant.
|
•
|
Under Annuity Option C, the death of the Annuitant and the end of the guaranteed period.
|
•
|
Under Annuity Options F and G, the death of the last surviving Joint Annuitant.
|
•
|
If this contract is solely owned, the Determining Life is the Owner.
|
•
|
If this contract is owned by a non-individual, the Determining Life is the Annuitant.
|
•
|
If this contract is jointly owned, the Determining Lives are the Joint Owners.
|
•
|
Increase its Index Option Value and Index Option Base by the amount of any Additional Purchase Payments and Transfers into the Index
Option received that day;
|
•
|
Reduce its Index Option Value and Index Option Base by the amount transferred out of the Index Option; and
|
•
|
Reduce its Index Option Value and Index Option Base for Withdrawals (including any Withdrawal Charge) and any applicable Contract
Charges.
|
•
|
The locked Index Option will not receive a Performance Credit on the Term End Date;
|
•
|
You cannot unlock a locked Index Option; and
|
•
|
The Index Option Value will not change until the earlier of the Business Day that we approve your Early Reallocation Request as described in the Early
Reallocation section, or the Index Anniversary that occurs on or immediately after the Lock Date, unless it is reduced for Withdrawals (including any corresponding Withdrawal Charges) or any Contract Charges.
|
•
|
We may limit transfers until the end of the Right to Examine period.
|
•
|
Any Transfer request must comply with the Allocation Guidelines shown on the Contract Schedule.
|
•
|
The New York Stock Exchange is closed, other than customary weekend and holiday closings.
|
•
|
Trading on the New York Stock Exchange is restricted.
|
•
|
An emergency, as determined by the Securities and Exchange Commission, exists as a result of which disposal of the Variable Option
shares held in the Variable Account are not reasonably practicable or we cannot reasonably value the Variable Option’s net asset value.
|
•
|
During any other period when the Securities and Exchange Commission, by order, so permits for the protection of Owners.
|
•
|
During the Accumulation Phase if the Contract Value on the Contract Anniversary before we deduct any other Contract Charges is at least
equal to the Contract Maintenance Charge Waiver Minimum.
|
•
|
During the Accumulation Phase if the Contract Value at the end of the last Business Day before you take a Full Withdrawal is at least
equal to the Contract Maintenance Charge Waiver Minimum.
|
•
|
During the Annuity Phase.
|
1.
|
Purchase Payments that are beyond the Withdrawal Charge period shown in the Withdrawal Charge Percentages Table. These Purchase
Payments no longer have a Withdrawal Charge Basis and are not subject to a Withdrawal Charge.
|
2.
|
Amounts that are available as Penalty-Free Withdrawals. These Withdrawals are not subject to a Withdrawal Charge, but do reduce the
Withdrawal Charge Basis(es).
|
3.
|
Withdrawal Charge Basis(es) that are within the Withdrawal Charge period shown in the Withdrawal Charge Percentages Table on a FIFO basis. These
Withdrawals are subject to a Withdrawal Charge, which is equal to the Withdrawal Charge Basis for the portion of each Purchase Payment being withdrawn multiplied by its applicable Withdrawal Charge percentage. The total Withdrawal Charge is
equal to the sum of the Withdrawal Charges for each Withdrawal Charge Basis. These Withdrawals reduce the Withdrawal Charge Basis.
|
4.
|
Any contract earnings. This Withdrawal is not subject to a Withdrawal Charge and it does not reduce the Withdrawal Charge Basis.
|
(a)
|
The Contract Value.
|
(b)
|
The total of all Purchase Payments received reduced proportionately by the percentage of Contract Value withdrawn as a Partial
Withdrawal, including any Withdrawal Charge.
|
•
|
For a sole Beneficiary, we determine (a) and (b) at the end of the Business Day we receive a Valid Claim from the Beneficiary.
|
•
|
For multiple Beneficiaries, we determine (b) for each surviving Beneficiary’s portion of the Traditional Death Benefit at the end of the
Business Day we receive the first Valid Claim from any one Beneficiary. We determine (a) for each surviving Beneficiary’s portion of the Traditional Death Benefit as of the end of the Business Day we receive the Beneficiary’s Valid Claim.
|
•
|
If any Determining Life dies before you, we compare (a) and (b) determined at the end of Business Day we receive due proof of a
Determining Life’s death. If (a) is less than (b), we increase (a) to equal (b). The difference between (b) and (a) will be placed in the Variable Option. The amount held in the Variable Option remains subject to the investment performance of
the Variable Option as described in the Contract Value section, and will be reduced by any Withdrawals and applicable Contract Charges. Except as provided in the Early Reallocation section, on the next Index Anniversary, we then allocate the
portion of the Death Benefit remaining in the Variable Option among your selected Allocation Options according to your allocation instructions.
|
•
|
If you die before any Determining Life, the Traditional Death Benefit ends, and the Death Benefit is each surviving Beneficiary’s portion of the Contract
Value at the end of the Business Day we receive the Beneficiary’s Valid Claim.
|
•
|
The Business Day that (a) and (b) are both zero.
|
•
|
The Business Day before the Annuity Date.
|
•
|
Upon the death of a Determining Life, the end of the Business Day we receive a Valid Claim from all Beneficiaries, if the Determining
Life is the Owner (or Annuitant if the Owner is a non-individual) or if the Determining Life dies simultaneously with the Owner.
|
•
|
Upon the death of a Determining Life, the end of the Business Day we receive an Authorized Request of due proof of the Determining Life’s death, if the
Determining Life is no longer an Owner (or Annuitant if the Owner is a non-individual).
|
•
|
Upon the death of an Owner (or Annuitant if the Owner is a non-individual), the end of the Business Day we receive the first Valid Claim from any one
Beneficiary, if the Owner is no longer a Determining Life.
|
•
|
The Business Day that this contract terminates.
|
•
|
the Accumulation Phase and/or the Annuity Phase terminates; and
|
•
|
if a Valid Claim has been received and all Death Benefit payments have been made.
|
•
|
The Internal Revenue Code, as amended.
|
•
|
Internal Revenue Service Rulings and Regulations.
|
•
|
Any requirements imposed by the Internal Revenue Service.
|
Contract Schedule
|
|||
Owner:
|
[John Doe]
|
Contract Number:
|
[687456]
|
[Joint Owner:
|
[Jane Doe]]
|
Issue Date:
|
[04/15/24]
|
Annuitant:
|
[John Doe]
|
Maximum Annuity Date:
|
[04/15/65]
|
Determining Life (Lives):
|
[John Doe]
|
Maximum Issue Age:
|
[85]
|
[Jane Doe]
|
0
|
8%
|
1
|
7%
|
2
|
6%
|
3
|
5%
|
4
|
3%
|
5
|
1%
|
6 years or more
|
0%
|
Contract Schedule continued from the previous page
|
TABLE 1: GUARANTEED PERIOD
Monthly installments per $1,000, payable for the guaranteed period
|
Guaranteed
Monthly
Period Installments
|
10 $8.75
|
TABLE 2: LIFE
Monthly installments per $1,000 payable while the Annuitant is living
|
|||
Guaranteed Rates for 2025
|
Guaranteed Rates for 2035
|
Guaranteed Rates for 2045
Female Male Annuitant Annuitant
3.18 3.07
4.41 4.19
7.13 6.16
|
|
Age of Annuitant on Annuity Date
|
Male Annuitant Female Annuitant
|
Male Female
Annuitant Annuitant
|
|
60
|
$3.35 3.20
|
3.26 3.13
|
|
70
|
4.71 4.41
|
4.55 4.30
|
|
80
|
7.73 7.04
|
7.41 6.82
|
|
LIFE WITH A GUARANTEED PERIOD - Male Annuitant
Monthly installments per $1,000, payable for the guaranteed period and thereafter while the Annuitant is living
|
|||
Guaranteed Rates for 2025
|
Guaranteed Rates for 2035
|
Guaranteed Rates for 2045
|
|
Age of Annuitant on
|
Guaranteed Period
|
Guaranteed Period
|
Guaranteed Period
|
Annuity Date
|
5 years 10 years
|
5 years 10 years
|
5 years 10 years
|
60
|
$3.34 3.32
|
3.26 3.23
|
3.18 3.16
|
70
|
4.67 4.56
|
4.52 4.43
|
4.39 4.31
|
80
|
7.46 6.67
|
7.20 6.52
|
6.96 6.39
|
Contract Schedule continued from the previous page
|
LIFE WITH A GUARANTEED PERIOD - Female Annuitant Monthly installments per $1,000, payable for the
guaranteed period and thereafter while the Annuitant is living
|
|||
Guaranteed Rates for 2025
|
Guaranteed Rates for 2035
|
Guaranteed Rates for 2045
|
|
Age of
Annuitant on
|
Guaranteed Period
|
Guaranteed Period
|
Guaranteed Period
|
Annuity Date
|
5 years 10 years
|
5 years 10 years
|
5 years 10 years
|
60
|
$3.19 3.17
|
3.13 3.11
|
3.07 3.06
|
70
|
4.39 4.31
|
4.28 4.21
|
4.18 4.12
|
80
|
6.86 6.28
|
6.67 6.17
|
6.49 6.05
|
TABLE 3: JOINT AND SURVIVOR ANNUITY
Monthly installments per $1,000, payable while either annuitant is living
|
|||
Guaranteed Rates for 2025
|
Guaranteed Rates for 2035
|
Guaranteed Rates for 2045
|
|
Age of Male Annuitant on Annuity Date
|
Age of Female Annuitant on Annuity Date
60 70 80
|
Age of Female Annuitant on Annuity Date
60 70 80
|
Age of Female Annuitant on Annuity Date
60 70 80
|
60
|
$2.81 3.12 3.27
|
2.77 3.05 3.19
|
2.73 3.00 3.12
|
70
|
3.05 3.75 4.34
|
2.99 3.67 4.23
|
2.94 3.60 4.12
|
80
|
3.15 4.19 5.72
|
3.09 4.09 5.56
|
3.03 4.01 5.42
|
TABLE 4: JOINT AND 2/3 SURVIVOR
Monthly installments per $1,000, payable while both Annuitants are living. After the death of one
Annuitant, 2/3 of the original installment amount will continue while the surviving Annuitant is living.
|
|||
Guaranteed Rates for 2025
|
Guaranteed Rates for 2035
|
Guaranteed Rates for 2045
|
|
Age of Male Annuitant on Annuity Date
|
Age of Female Annuitant on Annuity Date
60 70 80
|
Age of Female Annuitant on Annuity Date
60 70 80
|
Age of Female Annuitant on Annuity Date
60 70 80
|
60
|
$3.10 3.55 4.02
|
3.04 3.46 3.91
|
2.98 3.39 3.82
|
70
|
3.51 4.25 5.13
|
3.43 4.14 4.97
|
3.36 4.04 4.83
|
80
|
3.95 5.04 6.72
|
3.86 4.90 6.50
|
3.77 4.77 6.30
|
Variable Options
|
AZL® Government
Money Market Fund
|
Owner:
|
[John Doe]
|
Contract Number:
|
[687456]
|
[Joint Owner:
|
[Jane Doe]]
|
Issue Date:
|
[04/15/24]
|
Annuitant:
|
[John Doe]
|
Maximum Annuity Date:
|
[04/15/65]
|
Index Availability Period: |
[The period of time beginning on the Issue Date and ending on the day before the [sixth] Index Anniversary]
|
•
|
[Group A] Index Options can never be made temporarily unavailable for allocation on the Index Effective Date or an Index Anniversary.
|
•
|
[Group B] Index Options can be made temporarily unavailable for allocation at any time on the Index Effective Date or an Index
Anniversary.
|
•
|
[Group C] Index Options can be made temporarily unavailable for allocation on an Index Anniversary only after the
Index Availability Period shown above.
|
|
Index
|
Buffer for all Terms
|
Minimum Cap for all Terms
|
Term
|
Availability Identifier
|
[S&P 500® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[A]]
|
[Nasdaq-100® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[A]]
|
[Russell 2000® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[A]]
|
[EURO STOXX 50®
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[A]]
|
[S&P 500® Index
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
[Nasdaq-100® Index
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
[Russell 2000® Index
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
Allocation Options Contract Schedule continued from previous page
|
[EURO STOXX 50®
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
[S&P 500® Index
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]
|
[Nasdaq-100® Index
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]
|
[Russell 2000® Index
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]
|
[EURO STOXX 50®
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]]
|
Index
|
Buffer for all Terms
|
Minimum Cap for all Terms
|
Minimum Participation Rate for all Terms
|
Term
|
Availability Identifier
|
[S&P 500® Index
|
[10.00]%
|
[15.00]%
|
100.00%
|
[3 Index Years]
|
[A]]
|
[Nasdaq-100® Index
|
[10.00]%
|
[15.00]%
|
100.00%
|
[3 Index Years]
|
[A]]
|
[Russell 2000® Index
|
[10.00]%
|
[15.00]%
|
100.00%
|
[3 Index Years]
|
[A]]
|
[EURO STOXX 50®
|
[10.00]%
|
[15.00]%
|
100.00%
|
[3 Index Years]
|
[A]]
|
[S&P 500® Index
|
[20.00]%
|
[12.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[Nasdaq-100® Index
|
[20.00]%
|
[12.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[Russell 2000® Index
|
[20.00]%
|
[12.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[EURO STOXX 50®
|
[20.00]%
|
[12.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[S&P 500® Index
|
[30.00]%
|
[9.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[Nasdaq-100® Index
|
[30.00]%
|
[9.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[Russell 2000® Index
|
[30.00]%
|
[9.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[EURO STOXX 50®
|
[30.00]%
|
[9.00]%
|
100.00%
|
[3 Index Years]
|
[C]]
|
[S&P 500® Index
|
[10.00]%
|
[30.00]%
|
100.00%
|
[6 Index Years][*]
|
[A]]
|
[Nasdaq-100® Index
|
[10.00]%
|
[30.00]%
|
100.00%
|
[6 Index Years][*]
|
[A]]
|
[Russell 2000® Index
|
[10.00]%
|
[30.00]%
|
100.00%
|
[6 Index Years][*]
|
[A]]
|
[EURO STOXX 50®
|
[10.00]%
|
[30.00]%
|
100.00%
|
[6 Index Years][*]
|
[A]]
|
[S&P 500® Index
|
[20.00]%
|
[24.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]
|
[Nasdaq-100® Index
|
[20.00]%
|
[24.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]
|
[Russell 2000® Index
|
[20.00]%
|
[24.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]
|
[EURO STOXX 50®
|
[20.00]%
|
[24.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]
|
[S&P 500® Index
|
[30.00]%
|
[18.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]
|
Allocation Options Contract Schedule continued from previous page
|
[Nasdaq-100® Index
|
[30.00]%
|
[18.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]
|
[Russell 2000® Index
|
[30.00]%
|
[18.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]
|
[EURO STOXX 50®
|
[30.00]%
|
[18.00]%
|
100.00%
|
[6 Index Years][*]
|
[C]]]
|
Index
|
Buffer for all Terms
|
Minimum Trigger Rate for all Terms
|
Term
|
Availability Identifier
|
[S&P 500® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[C]]
|
[Nasdaq-100® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[C]]
|
[Russell 2000® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[C]]
|
[EURO STOXX 50®
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[C]]
|
[S&P 500® Index
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
[Nasdaq-100® Index
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
[Russell 2000® Index
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
[EURO STOXX 50®
|
[20.00]%
|
[4.00]%
|
[1 Index Year]
|
[C]]
|
[S&P 500® Index
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]
|
[Nasdaq-100® Index
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]
|
[Russell 2000® Index
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]
|
[EURO STOXX 50®
|
[30.00]%
|
[3.00]%
|
[1 Index Year]
|
[C]]
|
[S&P 500® Index
|
[10.00]%
|
[15.00]%
|
[3 Index Years]
|
[C]]
|
[Nasdaq-100® Index
|
[10.00]%
|
[15.00]%
|
[3 Index Years]
|
[C]]
|
[Russell 2000® Index
|
[10.00]%
|
[15.00]%
|
[3 Index Years]
|
[C]]
|
[EURO STOXX 50®
|
[10.00]%
|
[15.00]%
|
[3 Index Years]
|
[C]]
|
[S&P 500® Index
|
[20.00]%
|
[12.00]%
|
[3 Index Years]
|
[C]]
|
[Nasdaq-100® Index
|
[20.00]%
|
[12.00]%
|
[3 Index Years]
|
[C]]
|
[Russell 2000® Index
|
[20.00]%
|
[12.00]%
|
[3 Index Years]
|
[C]]
|
[EURO STOXX 50®
|
[20.00]%
|
[12.00]%
|
[3 Index Years]
|
[C]]
|
[S&P 500® Index
|
[30.00]%
|
[9.00]%
|
[3 Index Years]
|
[C]]
|
[Nasdaq-100® Index
|
[30.00]%
|
[9.00]%
|
[3 Index Years]
|
[C]]
|
[Russell 2000® Index
|
[30.00]%
|
[9.00]%
|
[3 Index Years]
|
[C]]
|
Allocation Options Contract Schedule continued from previous page
|
[EURO STOXX 50®
|
[30.00]%
|
[9.00]%
|
[3 Index Years]
|
[C]]
|
|
[S&P 500® Index
|
[10.00]%
|
[30.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[Nasdaq-100® Index
|
[10.00]%
|
[30.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[Russell 2000® Index
|
[10.00]%
|
[30.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[EURO STOXX 50®
|
[10.00]%
|
[30.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[S&P 500® Index
|
[20.00]%
|
[24.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[Nasdaq-100® Index
|
[20.00]%
|
[24.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[Russell 2000® Index
|
[20.00]%
|
[24.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[EURO STOXX 50®
|
[20.00]%
|
[24.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[S&P 500® Index
|
[30.00]%
|
[18.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[Nasdaq-100® Index
|
[30.00]%
|
[18.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[Russell 2000® Index
|
[30.00]%
|
[18.00]%
|
[6 Index Years][*]
|
[C]]
|
|
[EURO STOXX 50®
|
[30.00]%
|
[18.00]%
|
[6 Index Years][*]
|
[C]]]
|
Index
|
Buffer for all Terms
|
Minimum Trigger Rate for all Terms
|
Term
|
Availability Identifier
|
[S&P 500® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[Nasdaq-100® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[Russell 2000® Index
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[EURO STOXX 50®
|
[10.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[S&P 500® Index
|
[20.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[Nasdaq-100® Index
|
[20.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[Russell 2000® Index
|
[20.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[EURO STOXX 50®
|
[20.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[S&P 500® Index
|
[30.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[Nasdaq-100® Index
|
[30.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[Russell 2000® Index
|
[30.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]
|
[EURO STOXX 50®
|
[30.00]%
|
[5.00]%
|
[1 Index Year]
|
[B]]]
|
Allocation Options Contract Schedule continued from previous page
|
1.
|
Annuity Registration
|
Ownership is: [ | Individual/Joint | Qualified plan | Custodian | Trust (Include the date of the trust in the name.) Religious organization (e.g., Church) (subject to approval) Corporation (e.g., LLC or Nonprofit) (subject to approval) Endowment or Foundation (subject to approval)Partnership or limited partnership (subject to approval)] |
a.
|
Owner
|
Are you a U.S. Citizen?
|
Yes (If yes, then proceed to address.)
|
No (If no, then proceed to next question.)
|
Are you a non-resident alien?
|
Yes (If yes, then you are not eligible for this product.)
|
|
No (If no, then proceed to Country of Citizenship.)
|
Resident street address (required if different than the mailing address)
|
City
|
State
|
ZIP code
|
||
Mailing address
|
City
|
State
|
ZIP code
|
b.
|
Joint Owner [Must be legally recognized
spouse within the meaning of federal tax law.]
|
Relationship to Owner: |
Spouse under a legally recognized marriage within the meaning of federal tax law [ Other]
|
Resident street address (required if different than the mailing address)
|
City
|
State
|
ZIP code
|
||
Mailing address
|
City
|
State
|
ZIP code
|
1.
|
Annuity Registration (continued)
|
c.
|
Annuitant (complete if different from Owner or Joint Owner)
|
Gender: [
|
Male
|
Female]
|
||
Social Security Number/Tax Identification Number
|
Date of birth (mm/dd/yyyy)
|
Relationship of Annuitant to Owner:
|
Spouse under a legally recognized marriage within the meaning of federal tax law
|
|
[
|
Other ]
|
|
Is the Annuitant a U.S. Citizen?
|
Yes (If yes, then proceed to address.) No (If no, then proceed to next question.)
|
|
Is the Annuitant a non-resident alien?
|
Yes (If yes, then the Annuitant is not eligible for this product.)
|
|
No (If no, then proceed to Country of Citizenship.)
|
Resident street address (required if different than the mailing address)
|
City
|
State
|
ZIP code
|
||
Mailing address
|
City
|
State
|
ZIP code
|
2.
|
Index Effective Date (This section must be completed.)
|
•
|
The Index Effective Date can be any Business Day from the Issue Date up to and including
the first Quarterly Contract Anniversary. However, it cannot be the 29th, 30th, or 31st of a month. If the Index Effective Date would occur on the 29th, 30th, or 31st
of a month, or on a day that is not a Business Day, we change the Index Effective Date to be the next available Business Day.
|
•
|
If the Index Effective Date is not the Issue Date, Purchase Payments will be placed in the [AZL® Government Money
Market Fund] until the Index Effective Date.
|
[ |
Earliest Index Effective Date – If chosen, the earliest Index Effective Date is the Issue Date of the Contract when the initial Purchase Payment,
application, and requirements are received in good order. This option is not designed to accommodate multiple Purchase Payments (e.g., 1035 exchanges, tax
qualified transfers/rollovers, etc.) expected before the first Quarterly Contract Anniversary.
|
3.
|
Allocation Options
|
•
|
Allocations must be in whole percentages (e.g., 33.3% or dollars are not permitted) which total 100%.
|
•
|
If Purchase Payments are received before the Index Effective Date and you allocate to an Index Option, the following will occur:
|
-
|
Your Purchase Payments will be placed in the [AZL® Government Money Market Fund].
|
-
|
Then, on the Index Effective Date we will allocate your Contract Value among your selected Allocation Options below.
|
•
|
[If additional Purchase Payments are received after the Index Effective Date and you select an Index Option, then your Purchase
Payment will be placed in the [AZL® Government Money Market Fund] until the next Index Anniversary unless they are included in an Early Reallocation Request.]
|
•
|
We only allow allocations (both Purchase Payments and transfers of Contract Value) into the Index Options on the Index Effective
Date and on subsequent Term Start Dates.
|
•
|
We only allow transfers of Index Option Value from the Index Options to the Variable Option on a Term End Date.
|
10% Buffer
|
20% Buffer
|
30% Buffer
|
% S&P 500® Index
|
% S&P 500® Index
|
% S&P 500® Index
|
% Russell 2000® Index
|
% Russell 2000® Index
|
% Russell 2000® Index
|
% Nasdaq-100® Index
|
% Nasdaq-100® Index
|
% Nasdaq-100® Index
|
% EURO STOXX 50®
|
% EURO STOXX 50®
|
% EURO STOXX 50®
|
Index Performance Strategy with 3-Year Term
|
||
10% Buffer
|
20% Buffer
|
30% Buffer
|
% S&P 500® Index
|
% S&P 500® Index
|
% S&P 500® Index
|
% Russell 2000® Index
|
% Russell 2000® Index
|
% Russell 2000® Index
|
Index Performance Strategy with 6-Year Term
|
||
10% Buffer
|
20% Buffer
|
30% Buffer
|
% S&P 500® Index
|
% S&P 500® Index
|
% S&P 500® Index
|
% Russell 2000® Index
|
% Russell 2000® Index
|
% Russell 2000® Index
|
4. Beneficiary Designation (If additional space is needed, attach a complete list signed and dated
by Owner(s).)
|
|||||||||
Primary Contingent
|
Percentage
|
Relationship
|
Social Security Number/TIN Tax Identification Number
|
Phone number
|
|||||
Individual first name
|
MI
|
Last name
|
Date of birth (mm/dd/yyyy)
|
Gender
[ Male Female]
|
|||||
Qualified plan Custodian Trust (Include the date of trust in the name.) Charitable
Trust Non-individual Beneficiary name
|
Email
|
||||||||
Street address
|
City
|
State
|
ZIP code
|
||||||
Primary Contingent
|
Percentage
|
Relationship
|
Social Security Number/TIN Tax Identification Number
|
Phone number
|
|||||
Individual first name
|
MI
|
Last name
|
Date of birth (mm/dd/yyyy)
|
Gender
[ Male Female]
|
|||||
Qualified plan Custodian Trust (Include the date of trust in the name.) Charitable
Trust Non-individual Beneficiary name
|
Email
|
||||||||
Street address
|
City
|
State
|
ZIP code
|
||||||
Primary Contingent
|
Percentage
|
Relationship
|
Social Security Number/TIN Tax Identification Number
|
Phone number
|
|||||
Individual first name
|
MI
|
Last name
|
Date of birth (mm/dd/yyyy)
|
Gender
[ Male Female]
|
|||||
Qualified plan Custodian Trust (Include the date of trust in the name.) Charitable
Trust Non-individual Beneficiary name
|
Email
|
||||||||
Street address
|
City
|
State
|
ZIP code
|
5. Purchase Payment (This section must be completed.)
Make check(s) payable to Allianz Life Insurance Company of New York.
|
6. Plan specifics (This section must be
completed to indicate how this Contract should be issued. These are the only available options.)
|
8.
|
Certification of Taxpayer Identification Number
|
1.
|
The Taxpayer Identification Number shown on this form is correct or I am waiting for a number to be issued to me.
|
2.
|
I am not subject to backup withholding because:
|
a.
|
I am exempt from backup withholding, or
|
b.
|
I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of
|
c.
|
The IRS has notified me that I am no longer subject to backup withholding.
|
3.
|
I am a U.S. person, and
|
4.
|
The Foreign Account Tax Compliance Act (FATCA) code(s) entered on this form (if any) indicating that I am exempt from
FATCA reporting is correct.
|
•
|
I received a prospectus and have determined, to the best of my knowledge and belief, that the variable annuity applied for is not unsuitable for my investment objectives, financial situation, and financial needs. It is a long-term commitment to meet my financial needs and goals.
|
•
|
I understand that the Contract Value may increase or decrease depending on the investment results of the Allocation Options and that
there is no guaranteed minimum Variable Account Value. Investment in the contract may result in a loss of Purchase Payments.
|
•
|
I understand that I can lose money that I allocate to the Index Options. This may result in a loss of Purchase Payments.
|
•
|
To the best of my knowledge and belief, all statements and answers in this application are complete and true.
|
•
|
No representative is authorized to modify this agreement or waive any Allianz Life of NY rights or requirements.
|
•
|
If this contract is being funded by an indirect rollover, I have complied with the requirement that only one rollover is permitted within a one year
period from all of the IRAs I own.
|
10.
|
Financial Professional
|
•
|
I am FINRA registered and state licensed for variable annuity contracts in all required jurisdictions; and I provided the Owner(s) with
|
•
|
I certify that the statements of the Owner have been correctly recorded.
|
•
|
I hereby certify that I only used sales materials that were previously approved by Allianz Life of NY in my presentation.
|
•
|
I further certify that I left a copy of all sales material used during my presentation with the applicant.
|
•
|
I have provided the Owner with all appropriate disclosure and
replacement requirements prior to the completion of this application.
|
•
|
If this is a replacement, include a copy of each disclosure statement and a list of companies involved.
|
|
Financial Professional’s signature (Primary)
|
B/D Broker-Dealer Rep. ID
|
|
First and last name (please print)
|
Percent split
|
|
Address
|
Telephone number
|
|
Email
|
Cell phone number
|
|
Financial Professional’s signature (Secondary)
|
B/D Broker-Dealer Rep. ID
|
|
First and last name (please print)
|
Percent split
|
|
Email
|
Cell phone number
|
[
|
•
|
sponsor, endorse, sell or promote Allianz Life of NY products.
|
•
|
recommend that any person invest in Allianz Life of NY products or any other securities.
|
•
|
have any responsibility or liability for or make any decisions about the timing, amount or pricing of Allianz Life of NY products.
|
•
|
have any responsibility or liability for the administration, management or marketing of Allianz Life of NY products.
|
•
|
consider the needs of Allianz Life of NY products or the owners of Allianz Life of NY products in determining, composing or
calculating the EURO STOXX 50 or have any obligation to do so.
|
•
|
STOXX, Deutsche Börse Group and their licensors, research partners or data providers do not give any warranty, express or implied, and
exclude any liability about:
|
•
|
The results to be obtained by Allianz Life of NY products, the owner of Allianz Life of NY products or any other person in connection with
|
•
|
The accuracy, timeliness, and completeness of the EURO STOXX 50 and its data;
|
•
|
The merchantability and the fitness for a particular purpose or use of the EURO STOXX 50 and its data;
|
•
|
The performance of Allianz Life of NY products generally.
|
•
|
STOXX, Deutsche Börse Group and their licensors, research partners or data providers give no warranty and exclude any liability, for any
|
•
|
Under no circumstances will STOXX, Deutsche Börse Group or their licensors, research partners or data providers be liable (whether in negligence or otherwise) for any lost profits or indirect, punitive, special or consequential damages or losses, arising as a result of such errors, omissions or interruptions in the EURO
STOXX 50 or its data or generally in relation to Allianz Life of NY products, even in circumstances where STOXX, Deutsche Börse Group or their licensors, research partners or data providers are aware that such loss or damage may occur.
|
Signature Title Date
|
/s/ Jasmine M. Jirele
|
Board Chair and Chief Executive Officer
|
September 8, 2023
|
Jasmine M. Jirele
|
||
/s/ William E. Gaumond
|
Director, Chief Financial Officer and Treasurer
|
|
William E. Gaumond
|
||
/s/ Jesse J. Kling
|
Director, Vice President and Appointed Actuary
|
September 9, 2023
|
Jesse J. Kling
|
||
/s/ Eric J. Thomes
|
Director and President
|
September 13, 2023
|
Eric J. Thomes
|
||
/s/ Gary A. Smith
|
Director
|
September 8, 2023
|
Gary A. Smith
|
||
/s/ Martha Clark Goss
|
Director
|
September 13, 2023
|
Martha Clark Goss
|
||
/s/ Ronald M. Clark
|
Director
|
September 8, 2023
|
Ronald M. Clark
|
||
/s/ Lorraine Lods
|
Director
|
September 13, 2023
|
Lorraine Lods
|
||
/s/ Kevin E. Walker
|
Director
|
September 9, 2023
|
Kevin E. Walker
|
Allianz Life of NY Variable Account C
|
33 Act No.
|
NY VM II
|
33-26646
|
NY VM IV / Advantage
|
333-19699
|
NY Opportunity
|
333-75718
|
NY Charter II
|
333-105274
|
NY High Five
|
333-124767
|
NY Vision (legacy)
|
333-143195
|
Retirement Pro NY
|
333-167334
|
Vision NY (POS)
|
333-171428
|
Retirement Advantage NY
|
333-180722
|
Vision NY (ALIP)
|
333-182990
|
Index Advantage NY N-4
|
333-192949
|
Index Advantage NY MVP N-4
|
333-259866
|
Index Advantage+ NY N-4
|
TBD
|
Allianz Life Insurance Co of New York
|
33 Act No.
|
Index Advantage NY S-1
|
333-192948
|
Index Advantage NY S-1 Vers. 2
|
333-210671
|
Index Advantage NY S-1 Vers. 3
|
333-217304
|
Index Advantage NY S-1 Vers. 4
|
333-224317
|
Index Advantage NY S-1 Vers. 5
|
333-230916
|
Index Advantage NY S-1 Vers. 6
|
333-237622
|
Index Advantage NY S-1 Vers. 7
|
333-255308
|
Index Advantage NY S-1 Vers. 8
|
333-264350
|
Index Advantage NY MVP S-1 (eff 1-1-23)
|
333-259863
|
Index Advantage NY MVP S-1 Vers 2
|
333-271303
|
Index Advantage+ NY S-1
|
TBD
|
(i)
|
any Index gains during the Term subject to the applicable Trigger Rate, Cap and/or Participation Rate,
|
(ii)
|
for the Index Dual Precision Strategy, any Index losses less than or equal to the 10% Buffer,
|
• |
For an AMBC or AMC the strike price is equal to 1.
|
• |
For an OMC:
|
-
|
For Index Options without a Participation Rate, the strike price is equal to 1 plus the Cap.
|
-
|
For Index Options with a Participation Rate, the strike price is equal to 1 plus the Cap divided by the Participation Rate.
|
• |
For an OMP or IMBC the strike price is equal to 1 minus the Buffer, depending on the Index Option.
|
•
|
For an AMC or OMC the notional amount is equal to the Participation Rate
|
•
|
For an OMP the notional amount is equal to 1
|
Strike price
|
AMC = 1.00
|
OMC = 1.12
|
OMP = 0.90
|
1,000
|
|||
Term TD return
|
NA
|
||
Time remaining
|
1.00
|
||
Value of derivatives
|
AMC = 5.10%
|
OMC = 0.66%
|
OMP = 3.37%
|
Strike price
|
AMC = 1.00
|
OMC = 1.12
|
OMP = 0.90
|
Index Value
|
1,010
|
||
Term TD return
|
1.00%
|
||
Time remaining
|
0.92
|
||
Value of derivatives
|
AMC = 5.41%
|
OMC = 0.72%
|
OMP = 2.83%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (1.86% - 1.06%) = 0.80%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.06% x (1 - 0.92) =
0.09% |
Strike price
|
AMC = 1.00
|
OMC = 1.12
|
OMP = 0.90
|
Index Value
|
1,010
|
||
Term TD return
|
1.00%
|
||
Time remaining
|
0.92
|
||
Value of derivatives
|
AMC = 6.37%
|
OMC = 2.23%
|
OMP = 3.50%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (0.63% - 1.06%) = -0.43%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.06% x (1 - 0.92) = 0.09%
|
Strike price
|
AMC = 1.00
|
OMC = 1.12
|
OMP = 0.90
|
Index Value
|
950
|
||
Term TD return
|
-5.00%
|
||
Time remaining
|
0.75
|
||
Value of derivatives
|
AMC = 2.50%
|
OMC = 0.12%
|
OMP = 3.99%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (-1.61% - 1.06%) = -2.67%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.06% x (1 - 0.75) = 0.27%
|
Strike price
|
AMC = 1.00
|
OMC = 1.12
|
OMP = 0.90
|
Index Value
|
1100
|
||
Term TD return
|
10.00%
|
||
Time remaining
|
0.50
|
||
Value of derivatives
|
AMC = 10.33%
|
OMC = 2.16%
|
OMP = 0.36%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (7.82% - 1.06%) = 6.75%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.06% x (1 - 0.50) = 0.53%
|
Strike price
|
AMC = 1.00
|
OMC = 1.12
|
OMP = 0.90
|
Index Value
|
900
|
||
Term TD return
|
-10.00%
|
||
Time Remaining
|
0.50
|
||
Value of derivatives
|
AMC = 0.72%
|
OMC = 0.00%
|
OMP = 4.93%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (-4.21% - 1.06%) = -5.27%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.06% x (1 - 0.50) = 0.53%
|
Strike price
|
AMC = 1.00
|
OMC = 1.12
|
OMP = 0.90
|
Index Value
|
1095
|
||
Index YTD return
|
9.50%
|
||
Time remaining
|
0.08
|
||
Value of derivatives
|
AMC = 9.37%
|
OMC = 0.46%
|
OMP = 0.00%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (8.92% - 1.06%) = 7.86%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.06% x (1 - 0.08) = 0.97%
|
Month
|
Index Values
|
AMC
|
OMC
|
OMP
|
Proxy Value
|
Daily Adjustment
|
Index Option Value
|
Term Start Date
|
1,000
|
5.10%
|
0.66%
|
3.37%
|
1.06%
|
$0.00
|
$10,000.00
|
1
|
1,010
|
5.41%
|
0.72%
|
2.83%
|
1.86%
|
$89.16
|
$10,089.16
|
2
|
975
|
3.62%
|
0.29%
|
3.50%
|
-0.16%
|
-$104.73
|
$9,895.27
|
3
|
950
|
2.50%
|
0.12%
|
3.99%
|
-1.61%
|
-$240.54
|
$9,759.46
|
4
|
925
|
1.59%
|
0.04%
|
4.60%
|
-3.05%
|
-$376.16
|
$9,623.84
|
5
|
850
|
0.30%
|
0.00%
|
8.22%
|
-7.92%
|
-$853.97
|
$9,146.03
|
6
|
900
|
0.72%
|
0.00%
|
4.93%
|
-4.21%
|
-$473.86
|
$9,526.14
|
7
|
980
|
2.61%
|
0.07%
|
1.62%
|
0.92%
|
$47.62
|
$10,047.62
|
8
|
1,015
|
3.95%
|
0.14%
|
0.67%
|
3.13%
|
$277.54
|
$10,277.54
|
9
|
1,100
|
9.95%
|
1.39%
|
0.05%
|
8.51%
|
$824.60
|
$10,824.60
|
10
|
1,125
|
12.25%
|
2.10%
|
0.00%
|
10.15%
|
$996.95
|
$10,996.95
|
11
|
1,095
|
9.37%
|
0.46%
|
0.00%
|
8.92%
|
$882.86
|
$10,882.86
|
Term End Date
|
1,080
|
$10,800.00
|
Strike price
|
AMC = 1.00
|
OMC = 1.04
|
OMP = 0.70
|
Index Value
|
1,000
|
||
Term TD return
|
NA
|
||
Time remaining
|
1.00
|
||
Value of derivatives
|
AMC = 5.10%
|
OMC = 3.23%
|
OMP = 0.58%
|
Strike price
|
AMC = 1.00
|
OMC = 1.04
|
OMP = 0.70
|
Index Value
|
1,100
|
||
Term TD return
|
10.00%
|
||
Time remaining
|
0.50
|
||
Value of derivatives
|
AMC = 10.33%
|
OMC = 7.20%
|
OMP = 0.01%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (3.12% - 1.28%) = 1.84%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.28% x (1 - 0.50) = 0.64%
|
Strike price
|
AMC = 1.00
|
OMC = 1.04
|
OMP = 0.70
|
Index Value
|
900
|
||
Term TD return
|
-10.00%
|
||
Time remaining
|
0.50
|
||
Value of derivatives
|
AMC = 0.72%
|
OMC = 0.25%
|
OMP = 0.38%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (0.09% - 1.28%) = -1.19%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.28% x (1 - 0.50) = 0.64%
|
Strike price
|
AMC = 1.00
|
OMC = 1.50
|
OMP = 0.80
|
Notional amount
|
AMC = 1.00
|
OMC = 1.00
|
OMP = 1.00
|
Index Value
|
1,000
|
||
Term TD return
|
NA
|
||
Time remaining
|
1.00
|
||
Value of derivatives
|
AMC = 10.82%
|
OMC = 0.76%
|
OMP = 6.97%
|
Strike price
|
AMC = 1.00
|
OMC = 1.50
|
OMP = 0.80
|
Notional amount
|
AMC = 1.00
|
OMC = 1.00
|
OMP = 1.00
|
Index Value
|
1,100
|
||
Term TD return
|
10.00%
|
||
Time remaining
|
0.83
|
||
Value of derivatives
|
AMC = 15.61%
|
OMC = 1.28%
|
OMP = 3.95%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (10.38% - 3.09%) = 7.29%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 3.09% x (1 - 0.83) = 0.51%
|
Strike price
|
AMC = 1.00
|
OMC = 1.50
|
OMP = 0.80
|
Notional amount
|
AMC = 1.00
|
OMC = 1.00
|
OMP = 1.00
|
Index Value
|
900
|
||
Term TD return
|
-10.00%
|
||
Time remaining
|
0.83
|
||
Value of derivatives
|
AMC = 5.81%
|
OMC = 0.16%
|
OMP = 8.53%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (-2.88% - 3.09%) = -5.97%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 3.09% x (1 - 0.83) = 0.51%
|
Strike price
|
AMC = 1.00
|
OMC = NA
|
OMP = 0.80
|
Notional amount
|
AMC = 1.00
|
OMC = NA
|
OMP = 1.00
|
Index Value
|
1,000
|
||
Term TD return
|
NA
|
||
Time remaining
|
1.00
|
||
Value of derivatives
|
AMC = 10.82%
|
OMC = 0.00%
|
OMP = 6.97%
|
Strike price
|
AMC = 1.00
|
OMC = NA
|
OMP = 0.80
|
Notional amount
|
AMC = 1.00
|
OMC = NA
|
OMP = 1.00
|
Index Value
|
1,100
|
||
Term TD return
|
10.00%
|
||
Time remaining
|
0.83
|
||
Value of derivatives
|
AMC = 15.61%
|
OMC = 0.00%
|
OMP = 3.95%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (11.66% - 3.85%) = 7.81%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 3.85% x (1 - 0.83) = 0.64%
|
Strike price
|
AMC = 1.00
|
OMC = NA
|
OMP = 0.80
|
Notional amount
|
AMC = 1.00
|
OMC = NA
|
OMP = 1.00
|
Index Value
|
900
|
||
Term TD return
|
-10.00%
|
||
Time remaining
|
0.83
|
||
Value of derivatives
|
AMC = 5.81%
|
OMC = 0.00%
|
OMP = 8.53%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (-2.72% - 3.85%) = -6.57%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 3.85% x (1 - 0.83) = 0.64%
|
Strike price
|
AMC = 1.00
|
OMC = NA
|
OMP = 0.90
|
Notional amount
|
AMC = 1.10
|
OMC = NA
|
OMP = 1.00
|
Index Value
|
1,000
|
||
Term TD return
|
NA
|
||
Time remaining
|
1.00
|
||
Value of derivatives
|
AMC = 18.91%
|
OMC = 0.00%
|
OMP = 15.47%
|
Strike price
|
AMC = 1.00
|
OMC = NA
|
OMP = 0.90
|
Notional amount
|
AMC = 1.10
|
OMC = NA
|
OMP = 1.00
|
Index Value
|
1,100
|
||
Term TD return
|
10.00%
|
||
Time remaining
|
0.92
|
||
Value of derivatives
|
AMC = 24.31%
|
OMC = 0.00%
|
OMP = 11.94%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (12.37% - 3.44%) = 8.94%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 3.44% x (1 - 0.92) = 0.29%
|
Strike price
|
AMC = 1.00
|
OMC = NA
|
OMP = 0.90
|
Notional amount
|
AMC = 1.10
|
OMC = NA
|
OMP = 1.00
|
Index Value
|
900
|
||
Term TD return
|
-10.00%
|
||
Time remaining
|
0.92
|
||
Value of derivatives
|
AMC = 13.18%
|
OMC = 0.00%
|
OMP = 18.16%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (-4.98% - 3.44%) = -8.42%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 3.44% x (1 - 0.92) = 0.29%
|
Strike price
|
AMBC = 1.00
|
OMP = 0.90
|
Index Value
|
1,000
|
|
Term TD return
|
NA
|
|
Time remaining
|
1.00
|
|
Value of derivatives
|
AMBC = 42.32%
|
OMP = 3.37%
|
Strike price
|
AMBC = 1.00
|
OMP = 0.90
|
Index Value
|
1,100
|
|
Term TD return
|
10.00%
|
|
Time remaining
|
0.50
|
|
Value of derivatives
|
AMBC = 77.60%
|
OMP = 0.36%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (7.40% - 0.86%) = 6.54%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 0.86% x (1 - 0.50) = 0.43%
|
Strike price
|
AMBC = 1.00
|
OMP = 0.90
|
Index Value
|
900
|
|
Term TD return
|
-10.00%
|
|
Time remaining
|
0.50
|
|
Value of derivatives
|
AMBC = 12.96%
|
OMP = 4.93%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (-3.63% - 0.86%) = -4.49%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 0.86% x (1 - 0.50) = 0.43%
|
Strike price
|
IMBC = 0.90
|
OMP = 0.90
|
Index Value
|
1,000
|
|
Term TD return
|
NA
|
|
Time remaining
|
1.00
|
|
Value of derivatives
|
IMBC = 65.25%
|
OMP = 3.37%
|
Strike price
|
IMBC = 0.90
|
OMP = 0.90
|
Index Value
|
1,100
|
|
Term TD return
|
10.00%
|
|
Time remaining
|
0.50
|
|
Value of derivatives
|
IMBC = 92.36%
|
OMP = 0.36%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (6.11% - 1.19%) = 4.91%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.19% x (1 - 0.50) = 0.60%
|
Strike price
|
IMBC = 0.90
|
OMP = 0.90
|
Index Value
|
900
|
|
Term TD return
|
-10.00%
|
|
Time remaining
|
0.50
|
|
Value of derivatives
|
IMBC = 44.70%
|
OMP = 4.93%
|
(a) |
change in Proxy Value = (current Proxy Value – beginning Proxy Value) = (-1.80% - 1.19%) = -2.99%
|
(b) |
proxy interest = beginning Proxy Value x (1 - Time remaining) = 1.19% x (1 - 0.50) = 0.60%
|
Hypothetical Daily Adjustment when:
|
Hypothetical Performance Credit when:
|
|||||
Crediting Method/Term Length/Negative Index Performance Protection
|
Assumed Rate
|
The index is up 10% at the end of month six
|
The index is down 10% at the end of month six
|
The index is up 10% at the end of the Term
|
The index is down 10% at the end of the Term
|
|
Index Performance Strategy 1-Year Term with 10% Buffer
|
12% Cap
|
7.29%
|
-4.74%
|
10.00%
|
0.00%
|
|
Index Performance Strategy 1-Year Term with 30% Buffer
|
4% Cap
|
2.48%
|
-0.55%
|
4.00%
|
0.00%
|
|
Index Performance Strategy 3-Year Term with 20% Buffer
|
50% Cap
|
7.80%
|
-5.46%
|
10.00%
|
0.00%
|
|
Index Performance Strategy 3-Year Term with 20% Buffer
|
Uncapped with a 100% Participation Rate
|
8.46%
|
-5.93%
|
10.00%
|
0.00%
|
|
Index Performance Strategy 6-Year Term with 10% Buffer
|
Uncapped with a 110% Participation Rate
|
9.22%
|
-8.13%
|
11.00%
|
0.00%
|
|
Index Precision Strategy 1-year Term with 10% Buffer
|
10% Trigger Rate
|
6.97%
|
-4.06%
|
10.00%
|
0.00%
|
|
Index Dual Precision Strategy 1-year Term with 10% Buffer
|
7% Trigger Rate
|
5.51%
|
-2.39%
|
7.00%
|
7.00%
|
|
Security Type
|
Security Class Title
|
Fee Calculation or
Carry Forward Rule
|
Amount
Registered
|
Proposed Maximum
Offering Price
Per Unit
|
Maximum Aggregate
Offering Price
|
Fee Rate
|
Amount of
Registration Fee
|
Carry Forward Form Type
|
Carry Forward
File Number
|
Carry Forward
Initial effective
date
|
Filing Fee Previously
Paid in Connection
with Unsold Securities
to be Carried Forward
|
|
Newly Registered Securities
|
|||||||||||||
Fees to be Paid
|
Other
|
Registered Indexed Linked
Annuity Contract
and interests therein
|
457(o)
|
$1,000,000.00
|
N/A
|
$0
|
$147.60/m
|
$147.60
|
N/A
|
N/A
|
N/A
|
N/A
|
|
Fees Previously Paid
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
Carry Forward Securities - Rule 415(a)(6)
|
|||||||||||||
Carry
Forward
Securities
|
Other
|
Registered Indexed
Linked Annuity Contract
and interests therein
|
415(a)(6)
|
N/A
|
N/A
|
$0
|
N/A
|
NA
|
Form S-1
|
N/A
|
NA
|
NA
|
|
Total Offering Amounts
|
$0
|
$0
|
|||||||||||
Total Fees Previously Paid
|
|||||||||||||
Total Fee Offsets
|
|||||||||||||
Net Fees Due
|
$0
|
#4E>6=@4444 %
M%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 44
M44 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !111
M0 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%%
M!1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %
M%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 44
M44 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !111
M0 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%%
M!1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %
M%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 44
M44 %%%% !1110 4444 %%%% !1110 4444 %%%% !1110 4444 %%%% !111
M0 4444 %%%% "$@#). *^;/BMXL;7_%$MA"^;+3Y&C7!ZOT;\.*]J^(OB >&
M_!=[=J1Y\@$$ ]7;_P"MD_A7RP2[,6 ,<>M>T?'_P"_X AVNGYY:JGBFPEN?@
M1X4OHU+?8V'F?[*,''\]M;TG%1I2\[?F9SBVYHD\7:[>>)?@OI^I7A'G-J^T
MX]%605:^(-IYGP8\&7>/^/>&U5CZ*UOC^86N9NI5'P%LVR=IUXX_[]O7J=WH
MK:_\";"QB7=/_8]K+".Y=(T8#\<8_&IDU2<>RDQJ+G>_5(\3O?&>IWWA2V\.
MRMFUA*J?4A>5KT+P)G_A1/B__M[_ /2=*\R\.Z4VKZE \_^ R5MB5&,+1[HSH\[E>78ZSX+9_X5VN?^
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MK_>OH;X+:"FG^$1JKI_I&HMO)(Z*"0N/P
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M_C6^"_A&&+_B'T?\%L_\*ZAS_P _4W_H5?.
N>7JV!QGFECQYJ<_QK_.I;JTN
M+&X6(KB".ZMY()E
M#1R*593W!K,TGPOI&B3M-86B0R.,$J.U;%%"DTK %(0&!!Z&EHI 8-MX.T.T
MU 7T-C&MP&W!P.RVB-<6:HD#XY0(
Z@[%,B@\GH/6JOB2QTRZU;PG;16]J]B]Y
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M!K'U_P 36=GH^J&QU*R?4;6W=UA$JLZLHSRN P^S^0;<&+[.MMM+$_NQT'7MZ]:C;0K%@N?M6]00)/MDN_!QD%]VXC@<$XH
M BO;N[N=2AT^PG2WWVYN'G:+><9 4$@=\DGVXYXBFUTZ<]S!=QO+]C@66>Y
M0*B'<2% 4MG)V_3W%:-YIMK?O%).C^9%GRY(Y6C=<]0&4@X.!Q[5&NC6"Q31
M&$NL\:Q2^9(SEU7.,EB3GYCSUH RU\5QW45PMG:2SS0QL\GE21NJ $$,&PV
M<]!Z'\6P:]=&^L;=86G:=(/-^ZH3?'(Y(YY/R?D..M:,GA[3I5Q(MRYPREFN
MY2S*<94G=DKP/E/'MR:D_L33_,CD$+*\?E[&65P1L#*O0^CL/?/.: -"BHX8
M4MXA&A2(RIG+MT8C."5ZC
MC'J#574?$5[JFF6UCW\86]Y<06]M:2333L-BQRQL "
MK-EB&P" IR.O3K6[!9V]M \$40$3O)(RDD@L[%FZ^I8G'O5:WT2QM989(DES
M"[GCAA4Q@*D;L.O& .
M222?3H?\)9"T-S-'8W+16UN)YFR@VG+#9C=RV48>GO6G+I%E-$L;1NH21Y5:
M.5T=68DL0RD$9+'C/>F+H6FI;36ZVP$4T2PR+O;YD7.!G/\ M'GJ
?ZA?^NL?_H:U8IKH
MLBA6&0"&_$'(_44 .HHHH **** "BBB@ HHHH **** "BBB@ HHHH **** "
MBBB@ HHHH **** "BBB@ HHHH **** "BBB@ HHHH **** "BBB@ HHHH **
M** "BBB@ HHHH *^8O&O_([:U_U]R?SKZ=KYB\:_\CMK7_7W)_.@#"HHHI@%
M%%% !7NGP7_Y$Z[_ .P@_P#Z+CKPNO=/@O\ \B==_P#80?\ ]%QT
TC4]
M0N;JW-S+ T-P;D!$B*E/+DVKSDYR.O%=#0 4444 %%%% !1110!FI_R,T_\
MUYQ_^AO6E6:G_(S3_P#7G'_Z&]:5 '+_ !&_Y$#5_P#KFO\ Z&M?-M?27Q&_
MY$#5_P#KFO\ Z&M?-M, HHHH *]=^!__ #'O^W?_ -J5Y%7KOP/_ .8]_P!N
M_P#[4H R]5_Y#%]_U\2?^A&J=7-5_P"0Q??]?$G_ *$:ITQ!1110!J>&_P#D
M9-._Z^$_G7M->+>&_P#D9-._Z^$_G7M-)C/F+QK_ ,CMK7_7W)_.L*MWQK_R
M.VM?]?98E#M
M)C<3CO@GG\3]30!:HHHH **** "BBB@ HHHH **** ,U/^1FG_Z\X_\ T-ZT
MJS4_Y&:?_KSC_P#0WK2H Y?XC?\ (@:O_P!WR\T <19>
M&;RP\-^'E?1XKF2S=GO+$-&/,8J5#9)VLRY!Y/\ *G76BW3SW< $L&RF?T%=Y48GB:X> 2*9D579,\A6) /T)5OR- '!:?X&
MU'S9_M5V46XECAOOFS]L@6*+ICH2ZN.<':[>U0:3X;U:QU+2Y;G2I98XK*UA
MDV?9G"NA?=DN=PQN!RG7WXKT=F5$9V.%49)]J;%*DT*2QMN1U#*?4'D4