WAIVER OF WITHDRAWAL CHARGE ENDORSEMENT
This Endorsement forms a part of the Contract to which it is attached and is
effective as of the Issue Date of the Contract. In the case of any conflict with
any provision in the Contract, the provisions of this Endorsement will control.
The following provisions are added to the Contract:
After the first Contract Year, you can make a partial withdrawal without
incurring a withdrawal charge when the following conditions occur:
(a). The Contract Owner or Joint Owner is confined to a Skilled Nursing Facility
or Hospital;
(b). Such confinement is for a period of at least 90 consecutive days; and
(c). A licensed physician certifies in writing that such continued confinement
is necessary.
A Skilled Nursing Facility is an institution which is licensed by the state in
which it is located to provide skilled nursing care, intermediate nursing care
or custodial nursing care. A Hospital is an institution which is licensed as a
hospital by the state in which it is located, is supervised by a staff of
licensed physicians and operates primarily for the care and treatment of sick
and injured persons as inpatients for a charge.
The proof required by the Company for the above benefit shall include but not be
limited to, written certification from a licensed physician performing within
the scope of his or her license. The licensed physician must not be the Contract
Owner, Joint Owner, the Annuitant, Joint Annuitant, or the spouse, parent or
child of the Contract Owner, Joint Owner, Annuitant, or Joint Annuitant. If a
non-individual owns the Contract, then Contract Owner shall mean Annuitant.
This waiver will not apply if the Contract Owner or Joint Owner was confined in
a Skilled Nursing Facility or Hospital on the Issue Date. Proof of confinement
must be provided in a form satisfactory to the Company.
Withdrawals of amounts under the Contract may be subject to a 10% tax penalty in
addition to any income taxes due. You should consult your tax advisor before
making a withdrawal.
Signed for Allianz Life Insurance Company of North America by:
/s/ /s/
Vice President and Secretary President
S20221
