EX-4.b



 EX-99.4.b. Schedule Pages 

Contract Schedule 
  

							
	Owner:	  	[John Doe]	 	Contract Number:	  	[??687456]
	[Joint Owner:	  	[Jane Doe]]	 	Issue Date:	  	[04/15/10]
	Annuitant:	  	[John Doe]	 	Scheduled Annuity Date:	  	[04/01/65]
	Determining Life (Lives):	  	[John Doe]	 	Maximum Issue Age:	  	[80]
		  	[Jane Doe]	 		  	

 Purchase Payments 
  

			
	Initial Purchase Payment:	  	$[10,000.00]
	Minimum Additional Purchase Payment:	  	$[50.00]
	Maximum Total Purchase Payments:	  	$1 million; higher amounts may be accepted with our approval

 Transfers 
  

			
	Number of Free Transfers Permitted:	  	[12] each Contract Year
	Transfer Fee:	  	$25.00 for each transfer in excess of the free transfers permitted
	Transfer Index Anniversary:	  	Every [Sixth] Index Anniversary

 Contract Charges 
  

			
	Product Fee:	  	[1.25]%
	Contract Maintenance Charge:	  	$[50.00] each Contract Year
	Designated Amount:	  	Contract Value must be $[100,000.00] to waive the Contract Maintenance Charge

 Withdrawals 
  

			
	Minimum Partial Withdrawal:	  	$[100.00]
	Minimum Required Value:	  	$[2,000.00]
	Free Withdrawal Amount:	  	[10]% of total Purchase Payments

 Withdrawal Charge Percentages Table 
  

					
	 Number of Complete Years
Since Receipt of Purchase Payment
	  	Charge	 
	 0
	  	 	8.5	% 
	 1
	  	 	8	% 
	 2
	  	 	7	% 
	 3
	  	 	6	% 
	 4
	  	 	5	% 
	 5
	  	 	4	% 
	 6 years or more
	  	 	0	% 

 Annuity Payments 
  

			
	Minimum Annuity Payment:	  	$[100.00]
	Annuity Mortality Table:	  	[Annuity 2000 Mortality Table]
	Minimum Annual Annuity Payment Rate:	  	[1.00]%

 Riders: 

[The applicable riders based on the information from the application will populate this area.] 

  
 3 








 Guaranteed Purchase Rate Table 

Upon request, we will furnish rates for ages and guaranteed periods not shown. 

Annuity Options—Guaranteed monthly annuity payments per $1,000 

 

																																									
	 	  	Option 1	 	  	Option 2	 	  	Option 3	 	  	Option 4	 	  	Option 5	 
	 	  	 	 	  	10-year
guaranteed period	 	  	20-year
guaranteed period	 	  	100% joint and
survivor	 	  	10-year
guaranteed period	 	  	 	 
	 Age on

Annuity Date
	  	Male	 	  	Female	 	  	Male	 	  	Female	 	  	Male	 	  	Female	 	  	Male & Female
Same Age	 	  	Male & Female
Same Age	 	  	Male	 	  	Female	 
	 30
	  	 	[2.08	  	  	 	1.97	  	  	 	2.08	  	  	 	1.97	  	  	 	2.07	  	  	 	1.97	  	  	 	1.84	  	  	 	1.84	  	  	 	2.00	  	  	 	1.92	  
	 40
	  	 	2.45	  	  	 	2.29	  	  	 	2.45	  	  	 	2.29	  	  	 	2.42	  	  	 	2.28	  	  	 	2.10	  	  	 	2.10	  	  	 	2.29	  	  	 	2.19	  
	 50
	  	 	3.02	  	  	 	2.78	  	  	 	3.00	  	  	 	2.77	  	  	 	2.92	  	  	 	2.73	  	  	 	2.49	  	  	 	2.49	  	  	 	2.70	  	  	 	2.57	  
	 60
	  	 	3.95	  	  	 	3.57	  	  	 	3.87	  	  	 	3.53	  	  	 	3.59	  	  	 	3.37	  	  	 	3.12	  	  	 	3.11	  	  	 	3.29	  	  	 	3.14	  
	 70
	  	 	5.66	  	  	 	5.03	  	  	 	5.28	  	  	 	4.83	  	  	 	4.24	  	  	 	4.13	  	  	 	4.22	  	  	 	4.20	  	  	 	4.18	  	  	 	4.00	  
	 80
	  	 	8.93	  	  	 	8.09	  	  	 	7.07	  	  	 	6.79	  	  	 	4.55	  	  	 	4.53	  	  	 	6.37	  	  	 	6.04	  	  	 	5.54	  	  	 	5.38	  
	 90
	  	 	15.24	  	  	 	14.64	  	  	 	8.36	  	  	 	8.30	  	  	 	4.59	  	  	 	4.59	  	  	 	10.68	  	  	 	7.98	  	  	 	7.66	  	  	 	7.50	] 


  
 [3A] 








 Variable Options Contract Schedule 

 

							
	Owner:	  	[John Doe]	 	Contract Number:	  	[??687456]
	[Joint Owner:	  	[Jane Doe]]	 	Issue Date:	  	[04/15/10]
	Annuitant:	  	[John Doe]	 	Scheduled Annuity Date:	  	[04/15/65]

 Allocation Guidelines: 

1. [Currently, you can select up to [3] of the Variable Options. This number will not decrease after the Issue Date.] 

2. Allocations must be made in whole percentages. 
 Variable
Options: 
 Variable Account: [Allianz Life of New York Variable Account C]  

[AZL Money Market Fund 
 AZL MVP Balanced Index Strategy
Fund 
 AZL MVP Growth Index Strategy Fund]