N.M. Admin. Code § 13.19.2.22
NEW MEXICO SURPLUS LINES BROKER'S COUNTERSIGNATURE ENDORSEMENT
THIS ENDORSEMENT MUST BE ATTACHED TO THE POLICY
AS PART OF THE INSURANCE CONTRACT
This policy provides surplus lines insurance by an insurer not otherwise authorized to transact business in New Mexico. This policy is not subject to supervision, review or approval by the superintendent of insurance. The insurance so provided is not within the protection of any guaranty fund law of New Mexico designed to protect the public in the event of the insurer's insolvency.
POLICY NUMBER: ______________________________________________________________
NAME OF INSURED: ____________________________________________________________
CERTIFICATE NUMBER: _________________________________________________________
DATE POLICY SIGNED: __________________________________________________________
UNDERWRITING COMPANY: _____________________________________________________
_______________________________
Surplus Lines Brokers Signature
N.M. Admin. Code § 13.19.2.22