|
Minnesota
(State or other jurisdiction of
incorporation or organization)
|
6311
(Primary Standard Industrial
Classification Code Number)
|
41-1366075
(I.R.S. Employer
Identification No.)
|
|
The information in this prospectus
is not complete and may be changed. We cannot sell Allianz Index Advantage+SM
Variable Annuity pursuant to this
prospectus until the Registration Statement containing this prospectus 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
|
|
|
|
15
|
|
|
|
16
|
|
|
17
|
||
|
|
17
|
|
|
|
18
|
|
|
|
18
|
|
|
|
18
|
|
|
18
|
||
|
|
18
|
|
|
|
19
|
|
|
|
21
|
|
|
|
22
|
|
|
|
23
|
|
|
|
23
|
|
|
|
24
|
|
|
|
25
|
|
|
|
26
|
|
|
|
26
|
|
|
|
26
|
|
|
1.
|
26
|
|
|
|
27
|
|
|
|
27
|
|
|
|
29
|
|
|
2.
|
29
|
|
|
|
29
|
|
|
|
29
|
|
|
|
29
|
|
|
|
30
|
|
|
|
30
|
|
|
|
30
|
|
|
|
31
|
|
|
3.
|
31
|
|
|
|
31
|
|
|
|
32
|
|
|
|
32
|
|
|
|
33
|
|
|
|
33
|
|
|
4.
|
34
|
|
|
|
35
|
|
|
|
35
|
|
|
|
36
|
|
|
|
39
|
|
|
|
43
|
|
|
|
45
|
|
|
|
46
|
|
|
|
47
|
|
|
5.
|
48
|
|
|
|
49
|
|
|
|
49
|
|
|
|
51
|
|
|
6.
|
51
|
|
|
|
51
|
|
|
|
53
|
|
|
|
53
|
|
|
|
53
|
|
|
|
55
|
|
|
|
56
|
|
|
|
56
|
|
|
|
56
|
|
|
7.
|
56
|
|
|
|
57
|
|
|
|
57
|
|
|
|
58
|
|
|
|
58
|
|
|
8.
|
58
|
|
|
|
58
|
|
|
|
59
|
|
|
|
59
|
|
|
9.
|
61
|
|
|
10.
|
64
|
|
|
|
65
|
|
|
|
67
|
|
|
|
67
|
|
|
|
67
|
|
11.
|
68
|
|
|
|
68
|
|
|
|
68
|
|
|
|
69
|
|
|
|
69
|
|
|
|
69
|
|
|
|
69
|
|
|
|
70
|
|
|
|
71
|
|
|
|
71
|
|
|
|
71
|
|
|
|
72
|
|
|
|
72
|
|
|
|
72
|
|
|
|
72
|
|
|
|
74
|
|
|
|
74
|
|
|
|
74
|
|
|
|
75
|
|
|
|
75
|
|
|
|
75
|
|
|
|
75
|
|
|
|
75
|
|
|
12.
|
75
|
|
|
|
75
|
|
|
|
76
|
|
|
|
76
|
|
|
|
76
|
|
|
|
78
|
|
|
|
78
|
|
|
|
78
|
|
|
|
78
|
|
|
13.
|
78
|
|
|
|
78
|
|
|
|
83
|
|
|
|
93
|
|
|
|
93
|
|
|
|
94
|
|
14.
|
101
|
|
|
102
|
||
|
|
102
|
|
|
|
102
|
|
|
|
103
|
|
|
|
103
|
|
|
|
104
|
|
|
105
|
||
|
107
|
||
|
|
107
|
|
|
|
107
|
|
|
109
|
||
|
|
109
|
|
|
110
|
||
|
111
|
||
|
|
111
|
|
|
|
111
|
|
|
112
|
||
|
|
112
|
|
|
|
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 8.5% 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withdrawn, declining to 0% over that time period.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 $8,500.
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 amounts invested
in the Index Option that
is available for withdrawal. The Daily Adjustment also applies if
before the Term End Date
you execute a Performance Lock, annuitize the Contract, we pay a
death benefit, or we
deduct Contract fees and expenses. The Daily Adjustment may be
negative depending on
the applicable Crediting Method. You will lose money if the Daily
Adjustment is negative.
•Index Precision Strategy, Index Guard Strategy, and Index Performance
Strategy. Daily Adjustments under these Crediting Methods may be positive, negative,
or equal to zero. A negative Daily Adjustment will result in
loss. In extreme
circumstances, a negative Daily Adjustment could result in a loss
beyond the
protection of the 10% or 20% Buffer, or -10% Floor, as
applicable, but it cannot result
in a total loss of -100%.
•Index Protection Strategy with Trigger. Daily Adjustments under this
Crediting
Method may be positive or equal to zero, but cannot be negative.
|
Fee Tables
4. Valuing Your
Contract – Daily
Adjustment
6. Expenses –
Withdrawal
Charge
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.
|
Not Applicable
|
||
|
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 E –
Variable
Investment
Option Under
the Contract
|
||
|
Annual Fee
|
Minimum
|
Maximum
|
||
|
Base Contract(1)
|
1.26%
|
1.26%
|
||
|
Investment Options(2)
(Variable Investment Option fees and
expenses)
|
0.65%
|
0.65%
|
||
|
Optional Benefits Available for an Additional
Charge(3)
(for a single optional benefit, if elected)
|
0.20%
|
0.20%
|
||
|
|
(1)
As a percentage of the Charge Base, plus an amount attributable to
the estimated contract maintenance
charge based on expected Contract sales.
|
|
||
|
|
(2)
As a percentage of the AZL Government Money Market Fund’s average
daily net assets.
|
|
||
|
|
(3)
As a percentage of the Charge Base. This is the current charge for
the Maximum Anniversary Value Death
Benefit.
|
|
||
|
|
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 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:
$1,753
|
Highest Annual Cost:
$1,987
|
|
|
|
|
Assumes:
•Investment of $100,000 in the AZL
Government Money Market Fund (even
though you cannot select the fund for
investment)
•5% annual appreciation
•Traditional Death Benefit
•No additional Purchase Payments,
transfers, or withdrawals
•No financial adviser fees
|
Assumes:
•Investment of $100,000 in the AZL
Government Money Market Fund (even
though you cannot select the fund for
investment)
•5% annual appreciation
•Maximum Anniversary Value Death
Benefit with a 0.20% rider fee
•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.
• Withdrawals may be subject to income taxes, including a 10%
additional federal tax that
may apply to withdrawals taken before age 59 1∕2.
• 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.
• 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), annuitize the
Contract, execute a
Performance Lock, we pay a death benefit, or we deduct Contract
fees and expenses.
For more information see section 4, Valuing Your Contract - Daily
Adjustment; and
Appendix B – Daily Adjustment.
• The Traditional Death Benefit may not be modified, but it will
terminate if you take
withdrawals that reduce both the Contract 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 AZL Government Money
Market Fund and
the Index Options available under the Contract.
• The AZL Government Money Market Fund and each Index Option has
its own unique
risks.
• You should review the AZL Government Money Market Fund
prospectus and disclosures,
including risk factors, for each Index Option before making an
investment decision.
|
Risk Factors
|
||
|
|
RISKS
|
Prospectus
Location
|
||
|
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 and are subject to
our claims-paying ability and financial strength. More information
about Allianz Life,
including our financial strength ratings, is available upon
request by visiting
allianzlife.com/about/financial-ratings, or contacting us at (800) 624-0197.
|
Risk Factors
|
||
|
|
RESTRICTIONS
|
|
||
|
Investments
|
• Certain Index Options may not be available under your Contract.
• You cannot allocate Purchase Payments to the AZL Government
Money Market Fund.
The sole purpose of the AZL Government Money Market Fund is to
hold Purchase
Payments until they are transferred to your selected Index
Options.
• We restrict additional Purchase Payments during the Accumulation
Phase. Each Index
Year, you cannot add more than your initial amount (i.e., 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 a Performance Lock and request Early Reallocation, we
will move assets
into an Index Option on the Business Day we receive your Early
Reallocation request in
Good Order.
• You can typically transfer Index Option Value only on Term End
Dates. However, you can
transfer assets out of an Index Option Value 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.
• We reserve the right to close or substitute the AZL Government
Money Market Fund. We
also reserve the right to close Index Options and substitute
Indexes. We also reserve the
right to decline any or all Purchase Payments at any time on a
nondiscriminatory basis.
|
Risk Factors
3. Purchasing the
Contract
4. Valuing Your
Contract
5. AZL
Government
Money Market
Fund
Appendix A –
Available Indexes
|
||
|
Optional
Benefits
|
• The optional Maximum Anniversary Value Death Benefit may not be
modified.
Withdrawals may reduce the Maximum Anniversary Value Death
Benefit’s Guaranteed
Death Benefit Value by more than the value withdrawn and will end
the Maximum
Anniversary Value Death Benefit if the withdrawals reduce both
the Contract Value and
Guaranteed Death Benefit Value to zero.
|
10. Death Benefit
|
||
|
|
TAXES
|
|
||
|
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.
• Earnings under the Contract may be taxed at ordinary income
rates when withdrawn, and
you may have to pay a 10% additional federal tax if you take a
full or partial withdrawal
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
|
||
|
|
CONFLICTS
OF INTEREST
|
Prospectus
Location
|
||
|
Exchanges
|
Some Financial Professionals may have a financial incentive to
offer you a new contract in
place of the 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
Negative Index Performance
Protection
|
Currently
Available Indexes
|
Positive Index Performance
Participation Limit
|
|
Index Protection Strategy
with Trigger 1-year Term with
100% downside protection
|
• S&P 500® Index
• Russell 2000® Index
• Nasdaq-100® Index
• EURO STOXX 50®
• iShares® MSCI Emerging Markets ETF
|
• 1.50% minimum Trigger Rate
|
|
Index Precision Strategy
1-year Term with 10% Buffer
|
• S&P 500® Index
• Russell 2000® Index
• Nasdaq-100® Index
• EURO STOXX 50®
• iShares® MSCI Emerging Markets ETF
|
• 1.50% minimum Trigger Rate
|
|
Index Guard Strategy
1-year Term with -10% Floor
|
• S&P 500® Index
• Russell 2000® Index
• Nasdaq-100® Index
• EURO STOXX 50®
• iShares® MSCI Emerging Markets ETF
|
• 1.50% minimum Cap
|
|
Index Performance Strategy
1-year Term with 10% Buffer
|
• S&P 500® Index
• Russell 2000® Index
• Nasdaq-100® Index
• EURO STOXX 50®
• iShares® MSCI Emerging Markets ETF
|
• 1.50% minimum Cap
• Can be “uncapped” (i.e., we do not declare a
Cap for that Term)
|
|
Index Performance Strategy
3-year Term with 10% Buffer
|
• S&P 500® Index
• Russell 2000® Index
|
• 5% minimum Cap
• Can be uncapped
• 100% minimum Participation Rate
|
|
Index Performance Strategy
3-year Term with 20% Buffer
|
• S&P 500® Index
• Russell 2000® Index
|
• 5% minimum Cap
• Can be uncapped
• 100% minimum Participation Rate
|
|
Index Performance Strategy
6-year Term with 10% Buffer
|
• S&P 500® Index
• Russell 2000® Index
|
• 10% minimum Cap
• Can be uncapped
• 100% minimum Participation Rate
|
|
Number of Complete
Years Since
Purchase Payment
|
Withdrawal Charge
Amount
|
|
0
|
8.5%
|
|
1
|
8%
|
|
2
|
7%
|
|
3
|
6%
|
|
4
|
5%
|
|
5
|
4%
|
|
6 years or more
|
0%
|
|
|
Index Protection Strategy
with Trigger
|
Index Precision
Strategy
and
Index Performance
Strategy
|
Index
Guard
Strategy
|
|
Daily Adjustment Maximum Potential Loss
|
0%
|
99%
|
35%
|
|
(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 Charge Base)
|
1.25%
|
|
Optional Benefit Expenses – Maximum Anniversary Value
Death Benefit
(as a percentage of the Charge Base)
|
0.20%
|
|
(expenses that are deducted from the fund’s assets, including management fees,
distribution and/or service (12b-1) fees, and other expenses)
|
0.65%
|
|
|
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.
|
$11,334
|
$15,765
|
$20,065
|
$32,585
|
|
(2) If you annuitize your Contract at the end of the applicable time
period.
|
N/A*
|
$8,765
|
$15,065
|
$32,585
|
|
(3) If you do not surrender your Contract.
|
$2,834
|
$8,765
|
$15,065
|
$32,585
|
|
The COVID-19 pandemic has at times led to significant volatility and
negative returns in the financial markets. These
market conditions have impacted the performance of the Indexes to
which the Index Options are linked, as well as
securities held by the AZL Government Money Market Fund. If these
market conditions continue or reoccur, and
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. The COVID-19
pandemic has contributed to an uncertain and evolving economic
environment. The impact of the COVID-19 pandemic
and other interrelated factors (e.g., changes in interest rates,
rising inflation, actions of governmental authorities) on the
economic environment cannot be predicted with certainty, but they
could negatively affect the returns of an Index and
the level of Trigger Rates, Caps, and Participation Rates, and other
product features, and the overall performance of your
Contract.
The military invasion of Ukraine initiated by Russia in February 2022
and the resulting response by the United States
and other countries have led to economic disruptions, as well as
increased volatility and uncertainty in the financial
markets. It is not possible to predict the ultimate duration and
scope of the conflict, or the future impact on U.S. and
global economies and financial markets. The performance of the
Indexes to which the Index Options are linked, as well
as securities held by the AZL Government Money Market Fund, may be
adversely affected. This risk could be higher for
Indexes with exposure to European or Russian markets, including EURO
STOXX 50® and iShares® MSCI Emerging
Markets ETF. 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
the 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, 2012 through December 31, 2022
|
||||
|
|
S&P 500®
Index
|
Nasdaq-100®
Index
|
Russell 2000®
Index
|
EURO
STOXX 50®
|
iShares® MSCI
Emerging Markets ETF
|
|
Returns without dividends
|
14.84%
|
22.67%
|
12.57%
|
7.03%
|
3.79%
|
|
Returns with dividends
|
17.11%
|
24.05%
|
14.07%
|
10.88%
|
5.90%
|
|
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.
|
|
As a result of the COVID-19 pandemic and interrelated market factors
(e.g., market volatility changes in interest rates,
rising inflation, actions by governmental authorities), economic
uncertainties have arisen which could negatively impact
Allianz Life’s net income and surplus. The extent to which the
COVID-19 pandemic and these other market factors will
impact our business, net income, and surplus, as well as our capital
and liquidity position, will depend on future
developments, which are highly uncertain. For more information see
section 13, Information on Allianz Life – Business
and Operational Risks Relevant to the Contract.
|
|
Financial Adviser Fee
Withdrawal
|
Contract
Value
|
Guaranteed Death Benefit
Value for a Contract with the
Traditional Death Benefit
|
Guaranteed Death Benefit Value
for a Contract with the
Maximum Anniversary Value
Death Benefit
|
|
Prior to 1st years withdrawal
|
$ 100,000
|
$ 90,000
|
$ 105,000
|
|
$5,000 withdrawal (subject to an
|
|
|
|
|
8.5% withdrawal charge)
|
– [($5,000 ÷ (1 – 8.5%)]
|
|
|
|
Amount withdrawn
|
– $5,465
|
– [($5,465 ÷ 100,000) x 90,000]
|
– [($5,465 ÷ 100,000) x 105,000]
|
|
|
|
= - $4,919
|
= - $5,739
|
|
After 1st years withdrawal
|
$ 94,535
|
$ 85,081
|
$ 99,261
|
|
|
|
|
|
|
Prior to 2nd years withdrawal
|
$ 97,000
|
$ 85,081
|
$ 99,261
|
|
$5,000 withdrawal (not subject to a
|
|
|
|
|
withdrawal charge)
|
– $5,000
|
– [($5,000 ÷ 97,000) x 85,081]
|
– [($5,000 ÷ 97,000) x 99,261]
|
|
|
|
= - $4,386
|
= - $5,117
|
|
After 2nd years withdrawal
|
$ 92,000
|
$ 80,695
|
$ 94,414
|
|
|
|
|
|
|
Prior to 3rd years withdrawal
|
$ 80,0000
|
$ 80,695
|
$ 94,414
|
|
$5,000 withdrawal (not subject to a
|
– $5,000
|
– [($5,000 ÷ 80,000) x 80,695]
|
– [($5,000 ÷ 80,000) x 94,414]
|
|
withdrawal charge)
|
|
= - $5,044
|
= - $5,844
|
|
After 3rd years withdrawal
|
$ 75,000
|
$ 75,651
|
$ 88,260
|
|
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
|
|
• 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, and
– upon the surviving spouse’s death, his or her
Beneficiary(s) receives the Contract Value.
• If the deceased Owner was not a Determining Life, the
Traditional Death Benefit or Maximum Anniversary Value Death
Benefit are not available and the Beneficiary(s) 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 JOINTLY OWNED CONTRACTS: The sole primary
Beneficiary is the surviving Joint Owner regardless of
any other named primary Beneficiaries. If both Joint Owners die within
120 hours of each other, we pay the death
benefit to the named contingent Beneficiaries or equally to the estate
of the Joint Owners if there are no named
contingent Beneficiaries.
|
|
• NAMING AN ESTATE AS A BENEFICIARY: If an estate is
the Beneficiary, the estate must be the sole primary
Beneficiary, unless the Spouse is the sole primary Beneficiary. If the
Spouse is the sole primary Beneficiary, then an
estate can be a contingent beneficiary.
|
|
• 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, replacing Joint Owners with a Trust, or
adding a Joint Owner if that person is a spouse within the
meaning of federal tax law of the existing Owner.
|
|
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).
|
|
• Purchase Payments we hold in the AZL Government Money Market before transferring them to your selected
Index Options are subject to
Contract fees and expenses (e.g. contract maintenance charge), and market risk and
may lose value.
|
|
Variable Account Value increases when….
|
Variable Account Value decreases when….
|
|
• you make additional Purchase Payments and we hold them in
the AZL Government Money Market Fund before transferring
them to your selected Index Options, or
• there is positive AZL Government Money Market Fund
performance
|
• we take assets out of the AZL Government Money Market
Fund for withdrawals (including financial adviser fees that you
choose to have us pay from this Contract) or transfers to your
selected Index Options,
• there is negative AZL Government Money Market Fund
performance, or
• we deduct Contract fees and expenses
|
|
Contract fees and
expenses we deduct from the AZL Government Money Market Fund include the product fee, rider fee,
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 or
Contract Value transfer, 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) or Contract Value
transfer,
• 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 product fee, rider fee, 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 Precision Strategy, Index Guard Strategy, and Index Performance Strategy allow negative
Performance Credits. A negative Performance Credit means you can lose principal and previous earnings. These
losses could be significant.
|
|
• 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 a 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 Protection
Strategy with Trigger
|
• Most protection.
• If the Index loses value, the Performance Credit is zero. You do
not receive a negative Performance
Credit.
|
|
What is the asset protection?
|
|
|
Index Precision Strategy
|
• Less protection than the Index Protection Strategy with Trigger and
Index Guard 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. In a period of extreme negative market
performance, the risk of loss is
greater with the Index Precision Strategy than with the Index Guard
Strategy.
|
|
Index Guard Strategy
|
• Less protection than the Index Protection Strategy with Trigger,
but more than Index Precision
Strategy and Index Performance Strategy.
• Permits a negative Performance Credit down to the -10% Floor.
• Protection from significant losses.
• More sensitive to smaller negative market movements that persist
over time because the -10% Floor
reduces the impact of large negative market movements.
• In an extended period of smaller negative market returns, the risk
of loss is greater with the Index
Guard Strategy than with the Index Performance Strategy and Index
Precision Strategy.
• Provides certainty regarding the maximum loss in any Term.
|
|
Index Performance
Strategy
|
• Less protection than the Index Protection Strategy with Trigger and
Index Guard Strategy. 3-year
Term Index Options with 20% Buffer have more protection than what is
available with the Index
Precision Strategy.
• Buffer absorbs 10% or 20% 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 a period of extreme negative market
performance, the risk of loss is greater
with the Index Performance Strategy than with the Index Guard
Strategy.
• 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 Protection
Strategy with Trigger
|
• Growth opportunity limited by the Trigger Rates.
• Least growth opportunity.
• May perform best in periods of small positive market movements.
• These Trigger Rates will generally be less than Caps and the Index
Precision Strategy Trigger Rates.
|
|
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 Protection
Strategy with Trigger, but less than the
Index Performance Strategy.
• Growth opportunity may be more or less than the Index Guard
Strategy depending on Trigger Rates
and Caps.
|
|
Index Guard Strategy
|
• Growth opportunity limited by the Caps.
• May perform best in a strong market.
• Growth opportunity that generally may be matched or exceeded only
by the Index Performance
Strategy. However, growth opportunity may be more or less than the
Index Precision Strategy or
Index Performance Strategy depending on Trigger Rates and Caps.
|
|
What is the growth opportunity?
|
|
|
Index Performance
Strategy
|
• Growth opportunity limited by the Caps and/or Participation Rates.
If we do not declare a Cap for a
3-year or 6-year Term 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.
• Generally the most growth opportunity. However, growth opportunity
may be less than the Index
Precision Strategy or Index Guard Strategy depending on Trigger
Rates, Caps, and/or Participation
Rates.
|
|
What can change within a Crediting
Method?
|
|
|
Index Protection
Strategy with Trigger
|
• Renewal and Early Reallocation Trigger Rates for existing Contracts
can change on each Term Start
Date.
– 1-year Term has a 1.50% minimum Trigger Rate.
|
|
Index Precision Strategy
|
• Renewal and Early Reallocation Trigger Rates for existing Contracts
can change on each Term Start
Date.
– 1-year Term has a 1.50% 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 Guard Strategy
|
• Renewal and Early Reallocation Caps for existing Contracts can
change on each Term Start Date.
– 1-year Term has a 1.50% minimum Cap.
• The -10% Floors 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
Floor for it on the date we add the
Index Option to your Contract. The minimum Floor is -25% 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 10% Buffer has a 1.50% minimum Cap.
– 3-year Term with 10% or 20% Buffer has a 5% minimum Cap, and 100%
minimum Participation Rate.
– 6-year Term with 10% Buffer has a 10% minimum Cap, and 100% minimum
Participation Rate.
• The 10% or 20% 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.
|
|
• For any Index Option with the Index Precision Strategy or Index Performance Strategy, 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. However, for any
Index Option with the Index Guard Strategy, we absorb any negative Index Return in excess of the -10% Floor, so
your maximum loss is limited to
-10% of the Index Option Value due to negative Index Returns.
|
|
• 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 1.50%, 5%, 10%, or 100% as stated in the table above.
|
|
• 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. If this occurs on or before
the Index Effective Date, you are not
subject to the Daily Adjustment. 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, and between the 1-year Terms for the
Index Guard Strategy and Index Performance
Strategy. Initial, renewal, and Early Reallocation rates may also be different from Contract-to-Contract. For
example, assume that on August 3, 2023 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 2023,
|
|
– 14% renewal rate and 14% Early Reallocation rate for existing
Contracts issued in 2022, and
|
|
– 12% renewal rate and 13% Early Reallocation rate for existing
Contracts issued in 2021.
|
|
|
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 Index Option or the AZL Government Money Market Fund (if applicable) we deduct
Contract fees and expenses; we deduct Contract fees and expenses from
each Index Option and the AZL Government
Money Market Fund proportionately based on its percentage of Contract
Value.
|
|
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 Protection
Strategy with Trigger
1-year Term
|
Performance Credit is zero
|
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 Guard Strategy
1-year Term
|
Performance Credit is equal to the negative Index
Return subject to the -10% Floor
If the Index Return is…
• -8%, the Performance Credit is -8%.
• -12%, the Performance Credit is -10%.
|
Performance Credit is equal to the Index Return up
to the Cap set on the Term Start Date
Assume the Cap is 8%. If the Index Return is…
• 0%, the Performance Credit is zero.
• 6%, the Performance Credit is 6%.
• 12%, the Performance Credit is 8%.
|
|
Index Performance
Strategy 1-year Term
|
Performance Credit is equal to the negative Index
Return in excess of the 10% Buffer.
If the Index Return for the year is…
• -8%, the Performance Credit is zero.
• -12%, the Performance Credit is -2%.
|
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%.
|
|
Index Performance
Strategy 3-year Term
|
Performance Credit is equal to the negative Index
Return in excess of the 10% or 20% 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%.
If instead you select a 3-year Term Index Option with
20% Buffer. If the Index Return for the Term is…
• -19%, the Performance Credit is 0%.
• -24%, the Performance Credit is -4%.
|
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, then if 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%.
|
|
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 6-year Term
|
Performance Credit is equal to the negative Index
Return in excess of the 10% Buffer.
If the Index Return for the Term is…
• -19%, the Performance Credit is -9%.
• -24%, the Performance Credit is -14%.
|
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 95%. 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 90%.
If instead the Participation Rate
is 110% and the
6-year Term were uncapped, then if 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 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.
|
|
Currently the Contract does not offer any variable investment options
to which you can allocate money. If we were to
offer variable investment options 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
Charge Base)
|
|
Product Fee(1)
|
1.25%
|
|
Issue Date
|
Non-Quarterly Contract Anniversaries
|
Quarterly Contract Anniversaries*
|
|
• The Charge Base is
equal to your initial
Purchase Payment.
• We begin calculating
and accruing the
daily product fee, on
the day after the
Issue Date.
|
• First we calculate and accrue the daily product
fee, using the Charge Base. If this is a
non-Business Day we use the Charge Base from
the end of the prior Business Day.
• Then if this is a Business Day we
increase/decrease the Charge Base as follows.
– If we receive an additional Purchase
Payment, we increase the Charge Base by
the dollar amount we receive.
– If you take a partial withdrawal (including any
financial adviser fees that you choose to have
us pay from this Contract), or we deduct
Contract fees and expenses other than the
withdrawal charge, we decrease the Charge
Base by the percentage of Contract Value
withdrawn (including any withdrawal charge).
All withdrawals you take reduce the Charge
Base, even Penalty-Free Withdrawals.
|
• First we process all daily transactions and
determine your Contract Value. Daily
transactions include any gains/losses due to AZL
Government Money Market Fund performance or
application of any Daily Adjustment (or
Performance Credit if this is also the Term End
Date), any additional Purchase Payment, any
partial withdrawals you take (including financial
adviser fees that you choose to have us pay from
this Contract and any withdrawal charge), and
deductions we make for other Contract fees and
expenses (including deduction of the accrued
daily product fee for the prior
quarter). All
partial withdrawals you take reduce the Charge
Base, even Penalty-Free Withdrawals.
– We deduct the accrued product fee for the
prior quarter on a dollar for dollar basis from
the Contract Value, and proportionately from
each Index Option and the AZL Government
Money Market Fund.
• Then we set the Charge Base equal to this
Contract Value and we calculate and accrue the
next quarter’s daily product fee using the newly
set Charge Base.
* Or the next Business Day if the Quarterly Contract
Anniversary is a non-Business Day.
|
|
Example: Contract Value is $125,000; Charge
Base is $127,000; a $10,000 partial
withdrawal (including any withdrawal charge)
would decrease the Charge Base by $10,160.
[($10,000 ÷ $125,000) x $127,000]
Any increase/decrease to the Charge Base
will increase/decrease the daily product fee
we calculate and accrue on the next day.
|
||
|
Examples of how we
calculate the product fee are included in Appendix C.
|
||
|
We do not treat the deduction of the accrued product fee as a
withdrawal when computing your Guaranteed Death
Benefit Value (see section 10).
|
|
If on a Quarterly Contract Anniversary (or the next Business Day if
the Quarterly Contract Anniversary is a
non-Business Day) the Contract Value is less than the accrued product
fee, we deduct your total remaining Contract
Value to cover the accrued product fee and reduce your Contract Value
to zero. If the deduction of the accrued product
fee reduces your Contract Value to zero and your selected death
benefit has ended, we treat this as a full withdrawal and
your Contract ends.
|
|
When calculating the Maximum Anniversary Value, we deduct all
Contract fees and expenses on the Index Anniversary
(including the accrued product and rider fees if this is also a
Quarterly Contract Anniversary) before we capture any
annual investment gains. However, we do not treat the deduction of
the accrued rider fee as a withdrawal when
calculating the Maximum Anniversary Value (see section 10).
|
|
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, and they do not reduce the
Withdrawal Charge 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.
|
|
|
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 $55,000, which is subject to a 7%
withdrawal charge, and you receive $51,150. We determine
this amount as follows:
(amount withdrawn) x (1 – withdrawal charge) = the
amount you receive, or:
$55,000 x 0.93 = $51,150
Next we withdraw from the second Purchase Payment.
So far, you received $61,150 ($10,000 under the free
withdrawal privilege and $51,150 from the first Purchase
Payment which is now reduced to zero), so we withdraw
$8,850 from the second Purchase Payment to equal the
$70,000 you requested. The second Purchase Payment is
subject to an 8% withdrawal charge. We calculate the total
amount withdrawn and its withdrawal charge as follows:
(the amount you receive) ÷ (1 – withdrawal charge) =
amount withdrawn, or:
$8,850 ÷ 0.92 = $9,620.
|
|
|
Number of Complete Years
Since Purchase Payment
|
Withdrawal Charge
Amount
|
|
|
0
1
2
3
4
5
6 years or more
|
8.5%
8%
7%
6%
5%
4%
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 $74,620 from your Contract, of
which you received $70,000 and paid a withdrawal
charge of $4,620. We also reduced the 1st Purchase
Payment from $55,000 to $0, and your 2nd Purchase
Payment from $45,000 to $35,380 ($45,000 – $9,620).
|
|
|
• 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:
|
|
– prior Penalty-Free Withdrawals,
|
|
– 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) may also be
subject to ordinary income taxes, and a 10% additional federal tax if you are under age 59 1∕2, and the
amount
of Contract Value available for withdrawal may 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.
|
|
• For tax purposes in most instances, withdrawals from Non-Qualified Contracts are considered to come from earnings
first, not Purchase Payments.
|
|
|
Index Protection Strategy
with Trigger
|
Index Precision
Strategy
and
Index Performance
Strategy
|
Index
Guard
Strategy
|
|
Daily Adjustment Maximum Potential Loss
|
0%
|
99%
|
35%
|
|
(as a percentage of Index Option Value, applies for distributions
from an Index Option before any Term End Date)
|
|
|
|
|
• Withdrawals may be subject to a withdrawal charge, state and federal taxation, and a 10% additional federal tax if
you are under age 59 1∕2, and the amount of Contract Value available
for withdrawal may 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 each Joint Owner a check for half of the
withdrawal amount and tax report that 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 will 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.
|
|
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.
|
|
• 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.
|
|
• 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
|
Maximum
Fee
|
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.
|
None
|
• 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 may be subject to
income taxes, including a 10% additional
federal tax if taken 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.
|
None
|
• Only available during the Accumulation Phase.
• Only available to IRA or SEP IRA Contracts.
• Program withdrawals count against free
withdrawal privilege.
• Program withdrawals may be subject to
negative Daily Adjustments.
• Program withdrawals may be 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.
|
None
|
• 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 may be subject to
withdrawal charges and income taxes,
including a 10% additional federal tax if taken
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
|
Maximum
Fee
|
Brief Description of
Restrictions/Limitations
|
|
Waiver of
Withdrawal
Charge
Benefit
|
Waives withdrawal charges if you are confined
for care, or are unable to perform at least two out
of six activities of daily living (ADLs).
|
None
|
• Only available during the Accumulation Phase.
• Confinement must be for at least 90 days in a
120-day period and requires proof of stay.
• Inability to perform two ADLs must be for at
least 90 consecutive days and may require an
exam or tests by a physician.
• Not available on the Issue Date if any Owner
was confined to an eligible facility, or unable to
perform all six ADLs.
• 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 may be subject to
income taxes, including a 10% additional
federal tax if taken 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.
Examples of deductions for the impact of
financial adviser fees that you choose to have us
pay from this Contract on the death benefit is
included in section 1.
|
None
|
• 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
|
Maximum
Fee
|
Brief Description of
Restrictions/Limitations
|
|
Performance
Lock and
Early
Reallocations
|
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 and Early Reallocations.
|
None
|
• Available during the Accumulation Phase.
• Performance Locks may be executed before
the Term End Date for an Index Option.
• 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 Index Year, and will not
receive a Performance Credit.
• 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 Daily
Adjustment has declined, 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.
• Early Reallocation requests are not accepted
within 14 calendar days before an Index
Anniversary and are limited to two Early
Reallocation requests each Index Year.
• Deductions (e.g. withdrawals, fees) decrease
the locked Index Option Value.
• Cannot transfer Index Option Value until the
Term End Date unless you execute a
Performance Lock.
• 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.
|
|
Optional Benefits
|
|||
|
Name of
Benefit
|
Purpose
|
Maximum
Fee
|
Brief Description of
Restrictions/Limitations
|
|
Maximum
Anniversary
Value 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
the Maximum Anniversary Value.
An example of the death benefit provided by the
Maximum Anniversary Value Death Benefit, and
calculation of the Maximum Anniversary Value is
included in section 10, Death Benefit.
Examples of deductions for the impact of
financial adviser fees that you choose to have us
pay from this Contract on the death benefit is
included in section 1.
|
0.20%
(as a
percentage of
the Charge
Base)
|
• Must be age 75 or younger to elect.
• Can only be added to a Contract at issue.
• Replaces the Traditional Death Benefit if
elected.
• Benefit cannot be removed from the Contract.
• Only available during the Accumulation Phase.
• Withdrawals, including any negative Daily
Adjustment, may significantly reduce the
benefit as indicated in section 1, Financial
Adviser Fee Deduction Example.
• Withdrawals reduce the likelihood of lock in.
• Restrictions on Purchase Payments may limit
the benefit.
• Annuitizing the Contract will end the benefit.
|
|
|
Contract
Value
|
Maximum Anniversary Value
|
|
Issue Date
|
$ 100,000
|
$ 100,000
|
|
1st Index Anniversary
|
$ 110,000
|
$ 110,000
|
|
2nd Index Anniversary
|
$ 95,000
|
$ 110,000
|
|
|
Contract
Value
|
Maximum Anniversary Value
|
|
3rd Index Anniversary
|
$ 105,000
|
$ 110,000
|
|
4th Index Anniversary
|
$ 120,000
|
$ 120,000
|
|
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, and
|
|
• if you selected the Maximum Anniversary Value Death Benefit, we no longer assess its 0.20% rider fee.
|
|
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(s).
|
|
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.
|
|
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)
|
Salary
(c)
|
Bonus
(d)
|
Stock
Awards
(e)(3)
|
Non-Equity
Incentive Plan Compensation
(g)
|
All Other
Compensation
(i)(4)
|
Total
(j)
|
|
Walter R. White
President and Chief Executive Officer
|
2021
|
$865,100
|
$300,000
|
$2,335,770
|
$1,557,180
|
$22,665
|
$5,080,715
|
|
Jasmine M. Jirele(1,2)
President and Chief Executive Officer
|
2021
|
$561,958
|
$390,000
|
$1,068,303
|
$712,202
|
$22,516
|
$2,754,979
|
|
William E. Gaumond
Senior Vice President, Chief Financial
Officer and Treasurer
|
2021
|
$475,900
|
$300,000
|
$770,958
|
$513,972
|
$22,437
|
$2,083,267
|
|
Eric J. Thomes
Senior Vice President, Chief Distribution
Officer
|
2021
|
$535,500
|
$320,000
|
$867,510
|
$578,340
|
$22,548
|
$2,323,898
|
|
Neil H. McKay
Senior Vice President, Chief Actuary
|
2021
|
$510,000
|
$50,000
|
$926,200
|
$550,800
|
$24,397
|
$2,061,397
|
|
Gretchen Cepek
Senior Vice President, General Counsel and
Secretary
|
2021
|
$469,500
|
$110,000
|
$733,825
|
$422,550
|
$22,167
|
$1,758,042
|
|
Name
|
Year
|
Spousal
Travel(5)
|
Milestone/
Anniversary/
Recognition(6)
|
Life Insurance
Premiums
|
Employer Match
to 401(k) Plan
|
ASAAP
Contribution(7)
|
Total
|
|
Walter R. White
|
2021
|
--
|
--
|
$915
|
$21,750
|
--
|
$22,665
|
|
Jasmine M. Jirele
|
2021
|
--
|
$350
|
$416
|
$19,500
|
$2,250
|
$22,516
|
|
William E. Gaumond
|
2021
|
--
|
--
|
$687
|
$19,500
|
$2,250
|
$22,437
|
|
Eric J. Thomes
|
2021
|
--
|
--
|
$798
|
$19,500
|
$2,250
|
$22,548
|
|
Neil H. McKay
|
2021
|
$200
|
$1,700
|
$747
|
$21,750
|
--
|
$24,397
|
|
Gretchen Cepek
|
2021
|
--
|
--
|
$417
|
$21,750
|
--
|
$22,167
|
|
Name
(a)
|
Grant Date
(b)
|
Estimated Future Payouts Under
Non-Equity
Incentive Plan Awards(1)
|
Estimated Future Payouts Under Equity
Incentive
Plan Awards(2,3)
|
||||
|
Threshold ($)
(c)
|
Target ($)
(d)
|
Maximum ($)
(e)
|
Threshold ($)
(f)
|
Target ($)
(g)
|
Maximum ($)
(h)
|
||
|
Walter R. White
|
3/4/2022
|
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$1,557,180
|
$7,007,310
|
|
AIP Award
|
|
$0
|
$1,038,120
|
$1,557,180
|
|
|
|
|
Jasmine M. Jirele
|
3/4/2022
|
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$712,202
|
$3,204,909
|
|
AIP Award
|
|
$0
|
$474,802
|
$949,604
|
|
|
|
|
William E. Gaumond
|
3/4/2022
|
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$513,972
|
$2,312,874
|
|
AIP Award
|
|
$0
|
$342,648
|
$513,972
|
|
|
|
|
Eric J. Thomes
|
3/4/2022
|
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$578,340
|
$2,602,530
|
|
AIP Award
|
|
$0
|
$385,560
|
$578,340
|
|
|
|
|
Neil H. McKay
|
3/4/2022
|
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$550,800
|
$2,478,600
|
|
AIP Award
|
|
$0
|
$367,200
|
$550,800
|
|
|
|
|
Gretchen Cepek
|
3/4/2022
|
|
|
|
|
|
|
|
RSUs (under AEI)
|
|
|
|
|
$0
|
$422,550
|
$1,901,475
|
|
AIP Award
|
|
$0
|
$281,700
|
$422,550
|
|
|
|
|
Name
(a)
|
RSUs
|
|
|
Number of RSUs
That Have Not
Vested
(g)(1,2)
|
Market Value of
RSUs That Have
Not Vested
(h)(3)
|
|
|
Walter R. White
|
|
|
|
|
7,030
|
$1,637,920
|
|
|
5,239
|
$1,220,635
|
|
|
6,097
|
$1,420,540
|
|
|
8,139
|
$1,896,306
|
|
Jasmine M. Jirele
|
|
|
|
|
0
|
$0
|
|
|
1,467
|
$341,796
|
|
|
1,886
|
$439,419
|
|
|
2,407
|
$560,807
|
|
William E. Gaumond
|
|
|
|
|
2,039
|
$475,067
|
|
|
1,538
|
$358,339
|
|
|
1,948
|
$453,865
|
|
|
2,463
|
$573,854
|
|
Eric J. Thomes
|
|
|
|
|
492
|
$114,631
|
|
|
457
|
$106,476
|
|
|
1,474
|
$343,427
|
|
|
3,625
|
$844,589
|
|
Neil H. McKay
|
|
|
|
|
2,203
|
$513,277
|
|
|
1,731
|
$403,306
|
|
|
2,123
|
$494,638
|
|
|
2,503
|
$583,174
|
|
Gretchen Cepek
|
|
|
|
|
1,538
|
$358,339
|
|
|
1,413
|
$329,215
|
|
|
1,512
|
$352,281
|
|
|
1,789
|
$416,819
|
|
Name
|
Stock Awards
|
|
|
Number of
Shares
Acquired
on Vesting (#)
|
Value Realized
on Vesting ($)(1)
|
|
|
Walter R. White
|
8,161
|
$2,004,544
|
|
Jasmine M. Jirele
|
-
|
$0
|
|
William E. Gaumond
|
1,452
|
$356,647
|
|
Eric J. Thomes
|
617
|
$151,551
|
|
Neil H. McKay
|
2,550
|
$626,343
|
|
Gretchen Cepek
|
1,917
|
$470,863
|
|
NEOs
|
Lump Sum Payment
|
|
Walter R. White(1)
|
$1,730,200
|
|
Jasmine M. Jirele
|
$1,125,000
|
|
William E. Gaumond
|
$713,850
|
|
Eric J. Thomes
|
$803,250
|
|
Neil H. McKay
|
$765,000
|
|
Gretchen Cepek
|
$704,250
|
|
Name
|
Fees Earned
or Paid in
Cash
($)(1)
|
Total
($)
|
|
(a)
|
(b)
|
(h)
|
|
Andreas G. Wimmer(2)
Chair of the Board
|
N/A
|
N/A
|
|
Jasmine M. Jirele(3)
President and Chief Executive
Officer
|
N/A
|
N/A
|
|
William E. Gaumond(3)
Senior Vice President, Chief
Financial Officer and Treasurer
|
N/A
|
N/A
|
|
Walter R. White (3)
Former President and Chief
Executive Officer;
Non-Independent Director
|
N/A
|
N/A
|
|
Anna Sophie Herken(2)
Non-Independent Director
|
N/A
|
N/A
|
|
Howard E. Woolley
Independent Director
|
$60,000
|
$60,000
|
|
Kevin E. Walker
Independent Director
|
$60,000
|
$60,000
|
|
Udo Frank
Independent Director
|
$90,000
|
$90,000
|
|
ISSUE STATE
|
FEATURE AND BENEFITS
|
VARIATION
|
|
Investment Objectives
|
Variable Investment Option
and
Adviser/Subadviser
|
Current
Expenses
|
Average Annual Total Returns
(as of December 31, 2022)
|
||
|
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
|
0.64%
|
0.00%
|
0.53%
|
0.27%
|
|
To send an application, 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 North America
P.O. Box 59060
Minneapolis, MN 55459-0060
|
|
|
|
OVERNIGHT, CERTIFIED, OR REGISTERED MAIL
|
|
Allianz Life Insurance Company of North America
5701 Golden Hills Drive
Golden Valley, 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
|
$ 40,920
|
|
--------------
|
|
|
Estimated Printing and Filing Costs:
|
$ 30,000
|
|
--------------
|
|
|
Estimated Accounting Fees:
|
$ 75,000
|
|
---------------
|
|
|
Estimated Legal Fees:
|
$ 175,000
|
|
---------------
|
|
|
Estimated Miscellaneous Fees:
|
$ N/A
|
|
---------------
|
|
The Bylaws of the Insurance Company provide:
|
||
|
ARTICLE XI. INDEMNIFICATION OF DIRECTORS, OFFICERS AND EMPLOYEES
|
||
|
SECTION 1. RIGHT TO INDEMNIFICATION:
|
||
|
(a)
|
Subject to the conditions of this Article and any conditions or limitations imposed by applicable law, the Corporation shall indemnify any employee, director or officer of the
Corporation (an "Indemnified Person") who was, is, or in the sole opinion of the Corporation, may reasonably become a party to or otherwise involved in any Proceeding by reason of the fact that such Indemnified Person is or was:
|
|
|
(i)
|
a director of the Corporation; or
|
|
|
(ii)
|
acting in the course and scope of his or her duties as an officer or employee of the Corporation; or
|
|
|
(iii)
|
rendering Professional Services at the request of and for the benefit of the Corporation; or
|
|
|
(iv)
|
serving at the request of the Corporation as an officer, director, fiduciary or member of another corporation, association, committee, partnership, joint venture, trust, employee
benefit plan or other enterprise (an "Outside Organization").
|
|
|
(b)
|
Notwithstanding the foregoing, no officer, director or employee shall be indemnified pursuant to these bylaws under the following circumstances:
|
|
|
(i)
|
in connection with a Proceeding initiated by such person, in his or her own personal capacity, unless such initiation was authorized by the Board of Directors;
|
|
|
(ii)
|
if a court of competent jurisdiction finally determines that any indemnification hereunder is unlawful;
|
|
|
(iii)
|
for acts or omissions involving intentional misconduct or knowing and culpable violation of law;
|
|
|
(iv)
|
for acts or omissions that the Indemnified Person believes to be contrary to the best interests of the Corporation or its shareholders or that involve the absence of good faith on the
part of the Indemnified Person;
|
|
|
(v)
|
for any transaction for which the Indemnified Person derived an improper personal benefit;
|
|
|
(vi)
|
for acts or omissions that show a reckless disregard for the Indemnified Person's duty to the Corporation or its shareholders in circumstances in which the Indemnified Person was
aware or should have been aware, in the ordinary course of performing the Indemnified Person's duties, of the risk of serious injury to the Corporation or its shareholders;
|
|
|
(vii)
|
for acts or omissions that constitute an unexcused pattern of inattention that amounts to an abdication of the Indemnified Person's duties to the Corporation or its shareholders;
|
|
|
(viii)
|
in circumstances where indemnification is prohibited by applicable law;
|
|
|
(ix)
|
in the case of service as an officer, director, fiduciary or member of an Outside Organization, where the Indemnified Person was aware or should have been aware that the conduct in
question was outside the scope of the assignment as contemplated by the Corporation.
|
|
|
SECTION 2. SCOPE OF INDEMNIFICATION:
|
|
|
(a)
|
Indemnification provided pursuant to Section 1(a)(iv) shall be secondary and subordinate to indemnification or insurance provided to an Indemnified Person by an Outside Organization
or other source, if any.
|
|
(b)
|
Indemnification shall apply to all reasonable expenses, liability and losses, actually incurred or suffered by an Indemnified Person in connection with a Proceeding, including without
limitation, attorneys' fees and any expenses of establishing a right to indemnification or advancement under this article, judgments, fines, ERISA excise taxes or penalties, amounts paid or to be paid in settlement and all interest,
assessments and other charges paid or payable in connection with or in respect of such expense, liability and loss.
|
|
(c)
|
Such indemnification shall continue as to any Indemnified Person who has ceased to be an employee, director or officer of the Corporation and shall inure to the benefit of his or her
heirs, estate, executors and administrators.
|
|
SECTION 3. DEFINITIONS:
|
|
|
(a)
|
"Corporation" for the purpose of Article XI shall mean Allianz Life Insurance Company of North America and all of its subsidiaries.
|
|
(b)
|
"Proceeding" shall mean any threatened, pending, or completed action, suit or proceeding whether civil, criminal, administrative, investigative or otherwise, including actions by or
in the right of the Corporation to procure a judgment in its favor.
|
|
(c)
|
"Professional Services" shall mean services rendered pursuant to (i) a professional actuarial designation, (ii) a license to engage in the practice of law issued by a State Bar
Institution or (iii) a Certified Public Accountant designation issued by the American Institute of Certified Public Accountants.
|
|
Insofar as indemnification for liability arising under the Securities Act of 1933 may be permitted for directors and officers or controlling persons of the Insurance Company pursuant
to the foregoing, 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, 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 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.
|
|
|
1.(a)
|
Principal Underwriter Agreement by and between North American Life and Casualty Company on behalf
of NALAC Financial Plans, Inc. dated September 14, 1988 incorporated by reference as exhibit EX-99.B3.a. from Pre-Effective Amendment No.1 to Form N-4 (File Nos. 333-06709 and 811-05618), electronically filed on December 13, 1996. (North
American Life and Casualty Company is the predecessor to Allianz Life Insurance Company of North America. 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
North America and Allianz Life Financial Services, LLC, dated June 1, 2010 incorporated by reference as exhibit EX-99B3b. from Pre-Effective Amendment No. 1 to Form N-4 (File Nos. 333-166408 and 811-05618), electronically filed on September
24, 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 filing on 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 August 1, 2006, of Allianz Life Insurance
Company of North America, filed on January 3, 2013 as Exhibit 3(a) to Registrant's initial registration on Form S-1 (File No. 333-185864), is incorporated by reference.
|
|
(b)
|
Bylaws, as amended and restated August 1, 2006, of Allianz Life Insurance Company of North
America, filed on January 3, 2013 as Exhibit 3(b) to Registrant's initial registration on Form S-1 (File No. 333-185864), is incorporated by reference.
|
|
4.(a)*
|
|
||
|
(b)(i)*
|
|
||
|
(ii)*
|
|
||
|
(c)(i)*
|
|
||
|
(ii)*
|
|
||
|
(d)(i)*
|
|
||
|
(ii)*
|
|
||
|
(e)*
|
|
||
|
(f)*
|
|
||
|
(g)*
|
|
||
|
(h)*
|
|
||
|
(i)*
|
|
||
|
(j)*
|
|
||
|
(k)*
|
|
||
| 24. | (a) | Board Resolution, effective December 11, 2012, of the Board of Directors of Allianz Life Insurance Company of North America, filed on January 3, 2013 as Exhibit 24(b) to Registrant's Initial Registration on Form S-1 (File No. 333-185864), is incorporated by reference. |
| |
(b) Form of Board Resolution of the Board of Directors of Allianz Life Insurance Company of North
America, effective April 14, 2014, filed on April 14, 2014 as Exhibit 24(d) to Registrant's Post-Effective Amendment No. 2 to Form S-1 (File No. 333-185864), is incorporated by reference.
|
| |
(c)* |
| 99. | (a) | Alternative Minimum Value Exhibit - IXA-032 (05/2020), filed on April 9, 2020 as Exhibit 99(a) to Registrant’s Initial Registration on Form S-1 (File No. 333-237620), is incorporated by reference. |
| |
(b) |
Appendix B Exhibit – Daily Adjustment Calculation - IXA-010b (05/2021), filed on April 16, 2021, as Exhibit 99(b)
to Registrant's initial registration on Form S-1 (File No. 333-255306), is incorporated by reference.
|
| |
(c) |
Risk Factors Exhibit, filed on April 14, 2014 as Exhibit 99(c) to Registrant’s Post-Effective Amendment
No. 2 to Registrant’s Form S-1 (File No. 333-185864), is incorporated by reference.
|
| 107.* |
Filing Fee Table. | |
|
(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 liability arising under the Securities Act of 1933 may be permitted to directors, officers and controlling
persons of the Registrant pursuant to the foregoing provisions, or otherwise, the registrant 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 registrant of expenses incurred or paid by a director, officer or controlling person of the registrant
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 registrant 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 Jirele*
|
Director, President & Chief Executive Officer
|
|
|
Andreas G. Wimmer*
|
Director and Board Chair
|
|
|
Walter R. White*
|
Director
|
|
|
Udo Frank*
|
Director
|
|
|
William E. Gaumond*
|
Director, Senior Vice President, Chief Financial Officer and Treasurer (principal accounting officer)
|
|
|
Kevin E. Walker*
Anna Sophie Herken*
|
Director
Director
|
|
|
Howard E. Woolley*
|
Director
|
|
|
Exhibit
|
Description of Exhibit
|
|
4(a)
|
Individual Variable Annuity Contract-L40538-01
|
|
4(b)(i)
|
Contract Schedule-S40875-01
|
|
4(b)(ii)
|
Index Options Contract Schedule, S40877-02
|
|
4(c)(i)
|
Application for Individual Variable Annuity Contract, IXA-APP-04
|
|
4(c)(ii)
|
Annuity Purchase Acknowledgment, E-APA-VAR-03
|
|
4(d)(i)
|
Index Performance Strategy Rider II – S40903-01
|
|
4(d)(ii)
|
Index Performance Strategy Rider III, S40904-01
|
|
4(e)
|
Index Protection Strategy with Trigger Rider-S40879-02
|
|
4(f)
|
Traditional Death Benefit Rider-S40880-01
|
|
4(g)
|
Index Guard Strategy Rider-S40889-03
|
|
4(h)
|
Index Precision Strategy Rider-S40891-02
|
|
4(i)
|
Maximum Anniversary Value Death Benefit Rider, S40897-01
|
|
4(j)
|
Performance Lock Rider (with lock and go), S40908
|
|
4(k)
|
Waiver of Withdrawal Charge Rider, S40749-01
|
|
24(c)
|
Powers of Attorney
|
|
107
|
Filing Fee Table
|
|
Table of Contents
|
|
Definitions
|
|
•
|
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 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.
|
|
Definitions continued from the previous page
|
|
•
|
Increase the Charge Base by the amount of any Additional Purchase Payments received that day; and
|
|
•
|
Reduce the Charge Base proportionately by the percentage of any Contract Value withdrawn that day, including any Withdrawal Charges
and Contract Charges.
|
|
Definitions continued from the previous page
|
|
Purchase Payments continued from the previous page
|
|
•
|
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 Interim Fund(s)
shares are not reasonably practicable or we cannot reasonably value the Interim Fund(s) shares.
|
|
•
|
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 if the Contract Value is at least equal to the Contract Maintenance Charge Waiver Minimum at the end of
the last Business Day before the Annuity Date.
|
|
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, and do not 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(es).
|
|
4.
|
Any contract earnings. This Withdrawal is not subject to a Withdrawal Charge and it does not reduce the Withdrawal Charge Basis.
|
|
Death Benefit continued from the previous page
|
|
Ownership continued from the previous page
|
|
General Provisions continued from the previous page
|
|
•
|
the Index or Interim Fund is discontinued;
|
|
•
|
we are unable to use the Index because changes to the Index make it impractical or expensive to purchase derivative securities to
hedge the Index;
|
|
•
|
we are not licensed to use the Index or Interim Fund;
|
|
•
|
if the method of calculation of the Index or Interim Fund values changes substantially resulting in significantly different
performance results; or
|
|
•
|
it is determined in our sole discretion that such substitution is necessary.
|
|
General Provisions continued from the previous page
|
|
•
|
the Accumulation Phase and/or the Annuity Phase terminates; or
|
|
•
|
a Valid Claim has been received and all applicable Death Benefit payments have been made.
|
|
•
|
To retain its qualification for treatment as an annuity, whether under state or federal law, including the following:
|
|
•
|
The Internal Revenue Code, as amended.
|
|
•
|
Internal Revenue Service Rulings and Regulations.
|
|
•
|
Any requirements imposed by the Internal Revenue Service.
|
|
•
|
To add benefits to the contract that are beneficial to you.
|
|
Contract Schedule
|
|||
|
Owner:
|
[John Doe]
|
Contract Number:
|
[??687456]
|
|
Owner’s Date of Birth:
|
[January 15, 1977]
|
Issue Date:
|
[04/15/22]
|
|
Owner’s Gender:
|
[Male]
|
Maximum Issue Age:
|
[80]
|
|
[Joint Owner:
|
[Jane Doe]]
|
Annuitant:
|
[John Doe]
|
|
[Joint Owner’s Date of Birth:
|
[January 15, 1977]]
|
Annuitant’s Date of Birth:
|
[January 15, 1977]
|
|
[Joint Owner’s Gender:
|
[Female]]
|
Annuitant’s Gender:
|
[Male]
|
|
Determining Life (Lives):
|
[John Doe]
|
||
|
[Jane Doe]
|
|||
|
Number of Complete Years
Since Receipt of Purchase
Payment
|
Charge
|
|
[0
|
8.50%
|
|
1
|
8.00%
|
|
2
|
7.00%
|
|
3
|
6.00%
|
|
4
|
5.00%
|
|
5
|
4.00%
|
|
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
|
$[8.37]
|
|
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]
|
||||
|
Age of
Annuitant on Annuity Date
|
Male Annuitant
|
Female Annuitant
|
Male Annuitant
|
Female Annuitant
|
Male Annuitant
|
Female Annuitant
|
|
[60
|
$[2.91
|
2.76
|
2.83
|
2.70
|
2.76
|
2.65
|
|
70
|
4.26
|
3.97
|
4.11
|
3.86
|
3.98
|
3.76
|
|
80]
|
7.26
|
6.58
|
6.95
|
6.36
|
6.68
|
6.16]
|
|
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 Annuity Date
|
Guaranteed Period
|
Guaranteed Period
|
Guaranteed Period
|
|||
|
5 years
|
10 years
|
5 years
|
10 years
|
5 years
|
10 years
|
|
|
[60
|
$[2.91
|
2.89
|
2.83
|
2.81
|
2.75
|
2.74
|
|
70
|
4.24
|
4.14
|
4.09
|
4.01
|
3.96
|
3.89
|
|
80]
|
7.02
|
6.26
|
6.76
|
6.12
|
6.52
|
5.98]
|
|
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
|
||||||
|
Age of Annuitant on Annuity Date
|
Guaranteed Rates for [2025]
|
Guaranteed Rates for [2035]
|
Guaranteed Rates for [2045]
|
|||
|
Guaranteed Period
|
Guaranteed Period
|
Guaranteed Period
|
||||
|
5 years
|
10 years
|
5 years
|
10 years
|
5 years
|
10 years
|
|
|
[60
|
$[2.76
|
2.75
|
2.70
|
2.69
|
2.64
|
2.63
|
|
70
|
3.95
|
3.88
|
3.84
|
3.78
|
3.75
|
3.70
|
|
80]
|
6.42
|
5.87
|
6.23
|
5.75
|
6.05
|
5.64]
|
|
TABLE 3: JOINT AND SURVIVOR
|
|||||||||
|
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 Annuitant on Annuity Date
|
Age of Annuitant on Annuity Date
|
Age of Annuitant on Annuity Date
|
Age of Annuitant on Annuity Date
|
||||||
|
[60
|
70
|
80
|
60
|
70
|
80
|
60
|
70
|
80]
|
|
|
[60
|
$[2.35
|
2.60
|
2.72
|
2.31
|
2.56
|
2.66
|
2.28
|
2.51
|
2.61
|
|
70
|
2.60
|
3.25
|
3.73
|
2.56
|
3.18
|
3.64
|
2.51
|
3.12
|
3.55
|
|
80]
|
2.72
|
3.73
|
5.09
|
2.66
|
3.64
|
4.96
|
2.61
|
3.55
|
4.84]
|
|
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
Annuitant on Annuity Date
|
Age of Annuitant on Annuity Date
|
Age of Annuitant on Annuity Date
|
Age of Annuitant on Annuity Date
|
||||||
|
[60
|
70
|
80
|
60
|
70
|
80
|
60
|
70
|
80]
|
|
|
[60
|
$[2.61
|
3.01
|
3.40
|
2.56
|
2.94
|
3.32
|
2.51
|
2.88
|
3.25
|
|
70
|
3.01
|
3.70
|
4.46
|
2.94
|
3.60
|
4.34
|
2.88
|
3.52
|
4.23
|
|
80]
|
3.40
|
4.46
|
5.99
|
3.32
|
4.34
|
5.81
|
3.25
|
4.23
|
5.65]
|
|
Index Options Contract Schedule
|
|
Owner:
|
[John Doe]
|
Contract Number:
|
[??687456]
|
|
Owner’s Date of Birth:
|
[January 15, 1977]
|
Issue Date:
|
[04/15/22]
|
|
Owner’s Gender:
|
[Male]
|
Annuitant:
|
[John Doe]
|
|
[Joint Owner:
|
[Jane Doe]]
|
Annuitant’s Date of Birth:
|
[January 15, 1977]
|
|
[Joint Owner’s Date of Birth:
|
[January 15, 1977]]
|
Annuitant’s Gender:
|
[Male]
|
|
[Joint Owner’s Gender:
|
[Female]]
|
|
2.
|
Currently, you can select up to [5] of the Index Performance Strategy II Index Options.
|
|
3.
|
Currently, you can select up to [5] of the Index Performance Strategy III Index Options.
|
|
4.
|
Currently, you can select up to [5] of the Index Guard Strategy Index Options.
|
|
5.
|
Currently, you can select up to [5] of the Index Precision Strategy Index Options.
|
|
6.
|
Currently, you can select up to a maximum of [15] Index Options.
|
|
7.
|
Allocations must be made in whole percentages.]
|
|
Index
|
Minimum Trigger Rate for all Terms
|
Term length
|
|
S&P 500® Index
|
[1.50]%
|
[1 Index Year]
|
|
Nasdaq-100® Index
|
[1.50]%
|
[1 Index Year]
|
|
Russell 2000® Index
|
[1.50]%
|
[1 Index Year]
|
|
EURO STOXX 50®
|
[1.50]%
|
[1 Index Year]
|
|
iShares® MSCI
Emerging Markets ETF
|
[1.50]%
|
[1 Index Year]]
|
|
Index
|
Buffer for all Terms
|
Minimum Cap for all Terms
|
Term length
|
|
S&P 500® Index
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
Nasdaq-100® Index
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
Russell 2000® Index
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
EURO STOXX 50®
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
iShares® MSCI
Emerging Markets ETF
|
[10.00]%
|
[1.50]%
|
[1 Index Year]]
|
|
Index Options Contract Schedule continued from the previous page
|
|
Index
|
Buffer for all Terms
|
Minimum Cap for all Terms
|
Minimum Participation Rate for all Terms
|
Term length
|
|
S&P 500® Index
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
Nasdaq-100® Index
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
Russell 2000® Index
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
EURO STOXX 50®
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
iShares® MSCI
Emerging Markets ETF
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
S&P 500® Index
|
[20.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
Nasdaq-100® Index
|
[20.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
Russell 2000® Index
|
[20.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
EURO STOXX 50®
|
[20.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
iShares® MSCI
Emerging Markets ETF
|
[20.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
S&P 500® Index
|
[30.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
Nasdaq-100® Index
|
[30.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
Russell 2000® Index
|
[30.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
EURO STOXX 50®
|
[30.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
iShares® MSCI
Emerging Markets ETF
|
[30.00]%
|
[1.50]%
|
[100.00]%
|
[3 Index Years]
|
|
S&P 500® Index
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[6 Index Years]
|
|
Nasdaq-100® Index
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[6 Index Years]
|
|
Russell 2000® Index
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[6 Index Years]
|
|
EURO STOXX 50®
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[6 Index Years]
|
|
iShares® MSCI
Emerging Markets ETF
|
[10.00]%
|
[1.50]%
|
[100.00]%
|
[6 Index Years]]
|
|
Index Options Contract Schedule continued from the previous page
|
|
Index
|
Floor for all Terms
|
Minimum Cap for all Terms
|
Term length
|
|
S&P 500® Index
|
[-10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
Nasdaq-100® Index
|
[-10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
Russell 2000® Index
|
[-10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
EURO STOXX 50®
|
[-10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
iShares® MSCI
Emerging Markets ETF
|
[-10.00]%
|
[1.50]%
|
[1 Index Year]]
|
|
Index
|
Buffer for all Terms
|
Minimum Trigger Rate for all Terms
|
Term length
|
|
S&P 500® Index
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
Nasdaq-100® Index
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
Russell 2000® Index
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
EURO STOXX 50®
|
[10.00]%
|
[1.50]%
|
[1 Index Year]
|
|
iShares® MSCI Emerging Markets ETF
|
[10.00]%
|
[1.50]%
|
[1 Index Year]]
|
|
1.
|
Annuity Registration
|
|
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.)
|
|
Street address (required if a PO Box is being used for mailing address)
|
City
|
State
|
ZIP code
|
|||
|
Mailing address
|
City
|
State
|
ZIP code
|
|
b.
|
Joint Owner (Must be legally recognized spouses.)
|
|
Street address (required if a PO Box is being used for mailing address)
|
City
|
State
|
ZIP code
|
|||
|
Mailing address
|
City
|
State
|
ZIP code
|
|
1.
|
Annuity Registration (continued)
|
|
c.
|
Annuitant (complete if different from Owner)
|
|
Street address (required if a PO Box is being used for mailing address)
|
City
|
State
|
ZIP code
|
|||
|
Mailing address
|
City
|
State
|
ZIP code
|
|
2.
|
Optional Death Benefit
|
|
3.
|
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.
|
|
4.
|
Index 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 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 rebalance your Contract Value among your selected Allocation Options below.
|
|
•
|
[If additional Purchase Payments are received after the Index Effective Date then your Purchase Payment will be placed
in the [AZL® Government Money Market Fund] until the next Index Anniversary.]
|
|
•
|
[We only allow allocations (both Purchase Payments and transfers of Contract Value) into the Index Options on the
Index Effective Date and on subsequent Index Anniversaries.]
|
|
•
|
Please see the current prospectus for allocation requirements.
|
|
5. 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 1
|
Phone number
|
||||
|
Individual first name
|
MI
|
Last name
|
Date of birth (mm/dd/yyyy)1
|
[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 1
|
Phone number
|
||||
|
Individual first name
|
MI
|
Last name
|
Date of birth (mm/dd/yyyy)1
|
[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 1
|
Phone number
|
||||
|
Individual first name
|
MI
|
Last name
|
Date of birth (mm/dd/yyyy)1
|
[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
|
|||||
|
6. Purchase Payment (This section
must be completed.) Make check(s) payable to Allianz Life Insurance Company of North America (Allianz).
|
|
7.
|
Plan Specifics (This section must be completed to indicate
how this Contract should be issued.)
|
|
[Nonqualified:
|
Nonqualified
|
|||
|
Qualified plans:
|
401(k)
|
HR10/Keogh
|
Profit Sharing Plan
|
Money Purchase Pension Plan
|
|
8.
|
Replacement (This section must be completed.)
|
|
9.
|
Electronic Authorization
|
| [ |
Yes Allianz accepts allocation, transfer, Index Effective Date change instructions, Performance
Lock instructions, and other administrative instructions by electronic notification. Electronic authorizations include, but are not limited to, requests received by telephone, fax, email, or on our website. By selecting “yes”, I am
authorizing and directing Allianz to act on electronic instructions from my Financial Professional and/or any qualified person in the employ or administrative support of my Financial Professional to transfer and allocate Contract Value among
the variable investment options and any other available allocations options and authorization for Index Effective Date changes and Performance Locks. Notwithstanding my authorization to Allianz, I understand I must approve the transactions
recommended by my Financial Professional prior to submission to Allianz, unless I have separately and independently given my Financial Professional discretion over my contract. This authorization remains in effect until revoked by me. If I
have multiple Financial Professionals as my current Financial Professional, they may act independently.
|
|
10.
|
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 failure
|
|
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.
|
|
11.
|
Financial Professional
|
|
•
|
I am FINRA registered and state licensed for variable annuity contracts in all required jurisdictions; and I provided
the Owner(s) with
|
|
•
|
The Owner statement regarding existing policies or annuity contracts is true and accurate to the best of my knowledge
and belief.
|
|
•
|
The Owner statement as to whether or not an existing life insurance policy or annuity contract is being replaced is
true and accurate
|
|
•
|
I hereby certify that I only used sales materials that were previously approved by Allianz 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 Rep. ID
|
|
|
First and last name (please print)
|
Percent split
|
|
|
Address
|
Telephone number
|
|
|
Email
|
Cell phone number
|
|
|
Financial Professional’s signature (Secondary)
|
B/D Rep. ID
|
|
|
First and last name (please print)
|
Percent split
|
|
|
Email
|
Cell phone number
|
|
|
]
|
|
12.
|
Agreements and Signatures
|
|
•
|
I received a prospectus and have determined that the variable annuity applied for is not unsuitable for my investment
objectives,
|
|
•
|
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.
|
|
•
|
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 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.
|
|
•
|
sponsor, endorse, sell or promote Allianz products.
|
|
•
|
recommend that any person invest in Allianz products or any other securities.
|
|
•
|
have any responsibility or liability for or make any decisions about the timing, amount or pricing of Allianz products.
|
|
•
|
have any responsibility or liability for the administration, management or marketing of Allianz products.
|
|
•
|
consider the needs of Allianz products or the owners of Allianz 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 products, the owner of Allianz products or any other person in connection with the use of the EURO
|
|
•
|
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 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 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.
|
|
Verification of Existing Policies or Contracts
|
||
|
1. Do you have existing life insurance policies or annuity contracts?
|
Yes
|
No
|
|
2. Will the annuity contract applied for replace or change existing contracts or policies?
|
Yes
|
No
|
|
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.
|
|
a.
|
My financial professional electronically submitted a request for the purchase of an Allianz variable annuity on my
behalf and
|
|
b.
|
I received a prospectus and have determined 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.
|
|
c.
|
I understand that the variable annuity contract value may increase or decrease depending on the investment results
of the variable investment options, and that the contract by itself provides no guaranteed amount of minimum contract value.
|
|
1.
|
The applicant has existing life insurance policies or annuity contracts? YesNo
|
|
2.
|
This annuity contract will replace or change an existing policy or contract? YesNo
|
|
3.
|
I have provided the applicant with all appropriate disclosure and replacement requirements prior to electronic
submission.
|
|
4.
|
I hereby certify that I only used sales materials that were previously approved by Allianz in my presentation.
|
|
5.
|
I further certify that I left a copy of all sales material used during my presentation with the applicant.
|
|
•
|
Increase its Index Option Value and Index Option Base by the amount of any Additional Purchase Payments and Transfers into the Index
Option;
|
|
•
|
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 corresponding Withdrawal Charge or Partial MVAs),
Contract Charges, and/or Advisory Fees.
|
|
•
|
Increase its Index Option Value and Index Option Base by the amount of any Additional Purchase Payments and Transfers into the Index
Option;
|
|
•
|
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 corresponding Withdrawal Charge or Partial MVAs),
Contract Charges, and/or Advisory Fees.
|
|
•
|
Increase its Index Option Value and Index Option Base by the amount of any Additional Purchase Payments and Transfers into the Index
Option;
|
|
•
|
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 corresponding Withdrawal Charge or Partial MVAs),
Contract Charges, and/or Advisory Fees.
|
|
•
|
If the Base Contract is solely owned, the Determining Life is the Owner.
|
|
•
|
If the Base Contract is owned by a non-individual, the Determining Life is the Annuitant.
|
|
•
|
If the Base Contract is jointly owned and the Joint Owners are Spouses, the Determining Lives are the Joint Owners.
|
|
(a)
|
The Contract Value minus any final Contract Charges except the Contract Maintenance Charge.
|
|
(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 the (b) and (a) will be placed in the Interim Fund(s). On the next Index Anniversary, we then allocate the Variable Account Value in the
Interim Fund(s) among your selected Index Options according to your allocation instructions.
|
|
•
|
If you die before any Determining Life, the Traditional Death Benefit is unavailable and instead your Beneficiary(s) will receive the Death Benefit
described in the Base Contract.
|
|
•
|
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 the Base Contract terminates.
|
|
•
|
Increase its Index Option Value and Index Option Base by the amount of any Additional Purchase Payments and Transfers into the Index
Option;
|
|
•
|
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 corresponding Withdrawal Charge or Partial MVAs),
Contract Charges, and/or Advisory Fees.
|
|
•
|
Increase its Index Option Value and Index Option Base by the amount of any Additional Purchase Payments and Transfers into the Index
Option;
|
|
•
|
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 corresponding Withdrawal Charge or Partial MVAs),
Contract Charges, and/or Advisory Fees.
|
|
•
|
the Business Day we receive the first Valid Claim from any one Beneficiary; or
|
|
•
|
the older Determining Life’s Maximum Anniversary Value Death Benefit
Maximum Birthday shown on the Maximum Anniversary Value Death Benefit Contract Schedule.
|
|
•
|
If the Base Contract is solely owned, the Determining Life is the Owner.
|
|
•
|
If the Base Contract is owned by a non-individual, the Determining Life is the Annuitant.
|
|
•
|
If the Base Contract is jointly owned and the Joint Owners are Spouses, the Determining Lives are the Joint Owners.
|
|
•
|
increase the Maximum Anniversary Value by the amount of any Additional Purchase Payments received that day, and
|
|
•
|
reduce the Maximum Anniversary Value proportionately by the percentage of Contract Value withdrawn that day as a Partial Withdrawal,
including any Withdrawal Charge.
|
|
(a)
|
its current value after processing any Additional Purchase Payments or Partial Withdrawals; or
|
|
(b)
|
the Contract Value after processing any Daily Transactions.
|
|
(a)
|
The Contract Value minus any final Contract Charges except the Contract Maintenance Charge.
|
|
(b)
|
The Maximum Anniversary Value.
|
|
•
|
For a sole Beneficiary, we determine (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 Maximum Anniversary Value 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 Maximum Anniversary Value 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 the 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 (a) and (b) will be placed in the Interim Fund(s). On the next Index Anniversary, we then
allocate the Variable Account Value in the Interim Fund(s), among your selected Index Options according to your allocation instructions.
|
|
•
|
If you die before a Determining Life, the Maximum Anniversary Value Death Benefit is unavailable and instead your Beneficiary(s) will
receive the Death Benefit described in the Base Contract.
|
|
•
|
this rider terminates; or
|
|
•
|
we receive the first Valid Claim from any one Beneficiary, or due proof of a Determining Life’s death, if you and the Determining Life are different individuals and the Determining Life predeceases you.
|
|
•
|
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 the Base Contract terminates.
|
|
•
|
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 or the
Index Anniverary that occurs on or immediately after the Lock Date, unless it is reduced for Withdrawals (including any corresponding Withdrawal Charges or Partial MVAs), Contract Charges, and/or Advisory Fees.
|
|
•
|
Bathing: Washing oneself by sponge bath, in either a tub
or shower, including the task of getting into or out of the tub or shower without Substantial Assistance.
|
|
•
|
Continence: The ability to maintain control of bowel and bladder function,
or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene, including caring for a catheter or colostomy bag without Substantial Assistance.
|
|
•
|
Dressing: Putting on and taking off all items of clothing and any necessary
braces, fasteners, or artificial limbs without Substantial Assistance.
|
|
•
|
Eating: Feeding oneself by getting food into one’s body from a receptacle
(such as a plate, cup or table), or by feeding tube or intravenously without Substantial Assistance.
|
|
•
|
Toileting: Getting to and from the toilet, getting on and off the toilet,
and performing associated personal hygiene without Substantial Assistance.
|
|
•
|
Transferring: Moving into or out of a bed, chair, or wheelchair without
Substantial Assistance.
|
|
•
|
Is licensed or certified, if required by law.
|
|
•
|
Is primarily engaged in providing ongoing care and related services in a single location.
|
|
•
|
Has at least one trained staff member on duty 24 hours a day.
|
|
•
|
Provides continuous room and board.
|
|
•
|
Provides help or supervision for residents who are unable to perform activities of daily living or who have severe cognitive impairment.
|
|
•
|
Has formal procedures for managing all medical needs or emergencies, including the handling and dispensing of drugs and medical treatments (both
prescription and non-prescription).
|
|
•
|
Has formal arrangements for a physician or registered nurse (RN) to be available in an emergency.
|
|
•
|
An individual’s home.
|
|
•
|
An independent living facility or congregate housing for adults.
|
|
•
|
A facility that primarily provides domiciliary, residency, or retirement care, or is a training facility.
|
|
•
|
A convalescent home, board and rest home, or home for the aged.
|
|
•
|
An unlicensed or uncertified facility for which licensing and/or certification are required.
|
|
•
|
Is licensed as a hospital by the proper authority of the jurisdiction in which it is located.
|
|
•
|
Is accredited as a hospital by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
|
|
•
|
Operates as a hospital under law.
|
|
•
|
Is licensed as a nursing facility by the proper authority of the jurisdiction in which it is located.
|
|
•
|
Provides 24-hour services appropriate to the needs of residents and supervised by a licensed physician.
|
|
•
|
Provides medical and nursing services as needed, supervised by a licensed physician or RN.
|
|
•
|
Maintains a daily medical record of each patient.
|
|
•
|
is licensed to practice medicine and surgery and prescribe and administer drugs;
|
|
•
|
is legally qualified as a medical practitioner and required to be recognized, under this rider for insurance purposes, according to
applicable state insurance laws; or
|
|
•
|
meets the requirements of section 1861(r)(1) of the Social Security Act.
|
|
•
|
An Authorized Person begins confinement in an Eligible Facility after the first Contract Anniversary.
|
|
•
|
The same Authorized Person is confined to an Eligible Facility for at least 90 days in a 120-day period. The 90 day confinement does not
need to be consecutive.
|
|
•
|
We receive and accept Proof of Eligibility while the Authorized Person is confined to an Eligible Facility or no later than one year after the Authorized
Person is discharged.
|
|
•
|
On the Issue Date, the Authorized Person was able to perform without Substantial Assistance each ADL.
|
|
•
|
A Physician certifies that the Authorized Person is unable to perform without Substantial Assistance at least two ADLs for at least 90
continuous days.
|
|
•
|
Documentation that the facility is an Eligible Facility.
|
|
•
|
A copy of the Eligible Facility’s license or certification, if any.
|
|
•
|
Notice of the Physician certification, including documentation supported by clinical, radiological, histological, and laboratory
evidence of the certification. We will not require any medical receipts.
|
|
Signature
|
Title
|
Date
|
|
/s/ Jasmine M. Jirele
|
Director, President and Chief Executive Officer
|
November 7, 2022
|
|
Jasmine M. Jirele
|
||
|
/s/ Walter R. White
|
Director
|
November 4, 2022
|
|
Walter R. White
|
||
|
/s/ William E. Gaumond
|
Director, Senior Vice President, Chief Financial Officer and Treasurer
|
November 7, 2022
|
|
William E. Gaumond
|
||
|
/s/ Andreas G. Wimmer
|
Board Chair
|
November 7, 2022
|
|
Andreas G. Wimmer
|
||
|
/s/ Udo Frank
|
Director
|
November 2, 2022
|
|
Udo Frank
|
||
|
/s/ Kevin E. Walker
|
Director
|
November 4, 2022
|
|
Kevin E. Walker
|
||
|
/s/ Anna Sophie Herken
|
Director
|
November 4, 2022
|
|
Anna Sophie Herken
|
||
|
/s/ Howard E. Woolley
|
Director
|
November 3, 2022
|
|
Howard E. Woolley
|
|
Allianz Life Variable Account A
|
33 Act No.
|
|
ValueLife
|
33-11158
|
|
Valuemark Life
|
33-15464
|
|
Life Fund VUL
|
333-60206
|
|
Allianz Life Variable Account B
|
|
|
Valuemark II
|
33-23035
|
|
Valuemark III
|
33-72046
|
|
VIP
|
33-76190
|
|
Valuemark IV
|
333-06709
|
|
Charter
|
333-63719
|
|
Alterity
|
333-82329
|
|
Rewards
|
333-95729
|
|
Dimensions
|
333-47886
|
|
High Five
|
333-90260
|
|
Charter II
|
333-101812
|
|
High Five Bonus
|
333-111049
|
|
High Five L
|
333-120181
|
|
Custom Income
|
333-126217
|
|
Elite
|
333-134267
|
|
Vision (legacy vers)
|
333-139701
|
|
Connections – (RJ-legacy vers)
|
333-145866
|
|
Retirement Pro
|
333-166408
|
|
Connections – (WF-POS vers)
|
333-169265
|
|
Vision (POS vers)
|
333-171427
|
|
Retirement Advantage
|
333-180720
|
|
Vision (ALIP vers)
|
333-182987
|
|
Connections (ALIP vers)
|
333-182989
|
|
Index Advantage N-4
|
333-185866
|
|
Index Advantage ADV N-4
|
333-213127
|
|
Index Advantage NF N-4
|
333-215105
|
|
Index Advantage Income N-4
|
333-222815
|
|
Index Advantage Income ADV N-4
|
333-255394
|
|
Allianz Life Variable Account B
|
33 Act No.
|
|
Index Advantage+ 2.0 N-4
|
TBD
|
|
Index Advantage+ NF 2.0 N-4
|
TBD
|
|
Index Advantage+ Income 2.0 N-4
|
TBD
|
|
Allianz Life Insurance Co of North Am
|
|
|
Index Advantage S-1
|
333-185864
|
|
Index Advantage S-1 Vers. 2
|
333-195462
|
|
Index Advantage S-1 Vers. 3
|
333-210666
|
|
Index Advantage S-1 Vers. 4
|
333-217303
|
|
Index Advantage S-1 Vers. 5
|
333-224310
|
|
Index Advantage S-1 Vers. 6
|
333-230898
|
|
Index Advantage S-1 Vers. 7
|
333-237620
|
|
Index Advantage S-1 Vers 8
|
333-255306
|
|
Index Advantage S-1 Vers 9
|
333-264342
|
|
Index Advantage ADV S-1
|
333-213125
|
|
Index Advantage ADV S-1 Vers. 2
|
333-230899
|
|
Index Advantage ADV S-1 Vers. 3
|
333-264343
|
|
Index Advantage NF S-1
|
333-215103
|
|
Index Advantage NF S-1 Vers 2
|
333-237621
|
|
Index Advantage NF S-1 Vers 3
|
333-255307
|
|
Index Advantage NF S-1 Vers 4
|
333-264344
|
|
Index Advantage Income S-1
|
333-222817
|
|
Index Advantage Income S-1 Vers. 2
|
333-230901
|
|
Index Advantage Income S-1 Vers. 3
|
333-237628
|
|
Index Advantage Income S-1 Vers. 4
|
333-255317
|
|
Index Advantage Income S-1 Vers. 5
|
333-264345
|
|
Index Advantage Income ADV S-1
|
333-255386
|
|
Index Advantage Income ADV S-1 Vers2
|
333-264349
|
|
Index Advantage+ 2.0 S-1
|
TBD
|
|
Index Advantage+ NF 2.0 S-1
|
TBD
|
|
Index Advantage+ Income 2.0 S-1
|
TBD
|
|
|
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)
|
N/A
|
N/A
|
$0
|
$110.2/m
|
$0
|
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
|
||||||||||||