N.M. Admin. Code § 13.2.2.14
Current through Register Vol. 35, No. 21, November 5, 2024
Section 13.2.2.14 - FORM CA.When required: An insurer required by Section 59A-37-11 NMSA 1978 to file an annual registration statement shall file Form C in accordance with the requirements of this rule.B.Where filed: An insurer shall file a copy of Form C in each state in which the insurer is authorized to do business, if requested by the commissioner of that state.C.Information to be furnished in Form C:(1)Caption: Place the following caption at the top of the cover page: FORM C
SUMMARY OF CHANGES TO REGISTRATION STATEMENT FILED WITH THE NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE
(2)Registrant: State the name of the registrant filing the statement.(3)Other registrants: State the name and address of each insurance company on whose behalf the statement is being filed.(4)Date: Provide the filing date of the statement.(5)Designation of agent: State the name, title, address and telephone number of the individual to whom notices and correspondence concerning this statement should be addressed.(6)Changes: Furnish a brief description of all items in the current annual registration statement that represent changes from the prior year's annual registration statement in such a manner as to permit the proper evaluation of the changes by the superintendent. Include specific references to item numbers and captions in the annual registration statement and to the terms contained in them. (a)Changes in Paragraph (7) of Subsection G of 13.2.2.13 NMAC. Changes in the percentage of each class of voting securities held by each affiliate need only be included where such changes result in ownership or holdings of ten percent or more of voting securities, loss or transfer of control, or acquisition or loss of partnership interest.(b)Changes in Paragraph (9) of Subsection G of 13.2.2.13 NMAC. Include this information only if an individual is, for the first time, made a director or executive officer of the ultimate controlling person; an individual is named president of the ultimate controlling person; or a director or executive officer terminates his or her responsibilities with the ultimate controlling person.(c)Changes in Paragraph (10) of Subsection G of 13.2.2.13 NMAC. If a transaction disclosed on the prior year's annual registration statement has been changed, describe the nature of such change. If a transaction disclosed on the prior year's annual registration statement has been effectuated, furnish the mode of completion and any flow of funds between affiliates resulting from the transaction. The insurer shall furnish a statement that transactions entered into since the filing of the prior year's annual registration statement are not part of a plan or series of like transactions whose purpose it is to avoid statutory threshold amounts and the review that might otherwise occur.(7)Signature and certification: The following signature and certification are required at the end of Form C: Pursuant to the requirements of Section 59A-37-12 NMSA 1978 has caused this annual registration statement to be duly signed on its behalf in the city of and state of New Mexico on.
(SEAL)
____________________________
(Name of applicant)
BY:_________________________
Attest:
____________________________
(Signature of officer)
____________________________
(Title)
The undersigned deposes and says that they have duly executed the attached annual registration statement dated, for and on behalf of ; that they are the of such company; and that they are authorized to execute and file this instrument. Deponent further says that they are familiar with the instrument and its contents, and that the facts set forth in the instrument are true to the best of their knowledge, information and belief.
____________________________
(Signature of deponent)
____________________________
(Typed name and title of deponent)
N.M. Admin. Code § 13.2.2.14
7/1/97; Recompiled 11/30/01, Adopted by New Mexico Register, Volume XXIX, Issue 14, July 24, 2018, eff. 7/24/2018