N.M. Admin. Code § 13.3.2.18
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
(To be filed with the department of insurance pursuant to Section 59A-36-2 NMSA 1978.)
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(Name of insurance company)
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(Name of person whose ownership is reported)
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(Business address of such person) (street) (city) (state) (zip code)
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Relationship of such person to company named above. (See 13 NMAC 3.2.11) [now 13.3.2.11 NMAC]
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Date of event which requires the filing of this statement. (See 13 NMAC 3.2.12) [now 13.3.2.12 NMAC]
SECURITIES BENEFICIALLY OWNED
| TITLE OF SECURITY (See 13 nmac 3.2.13 [now 13.3.2.13 NMAC] | NATURE OF OWNERSHIP (See 13 nmac 3.2.14) [now 13.3.2.14 NMAC] | AMOUNT OWNED BENEFICIALLY (See 13 NMAC 3.2.15) [now 13.3.2.15 NMAC] |
REMARKS: (see 13 NMAC 3.2.16) [now 13.3.2.16 NMAC]
Date of statement: ________________________________________
I affirm under penalty or perjury that the foregoing is full, true and correct.
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Signature
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(Signature guaranteed)
N.M. Admin. Code § 13.3.2.18