N.M. Admin. Code § 13.3.3.20
STATEMENT OF CHANGES IN 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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Social security number
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Relationship of such person to company named above. (See 13 NMAC 3.3.11) [now 13.3.3.11 NMAC]
STATEMENT FOR CALENDAR MONTH OF ________, 19____
CHANGES DURING MONTH AND MONTH-END OWNERSHIP
(See 13 nmac 3.3.12) [now 13.3.3.12 NMAC]
| Title OfSecurity (See 13 NMAC 3.3.13) [now 13.3.3.13 NMAC] | Date ofTrans-Action (See 13 NMAC 3.3.14) [now 13.3.3.14 NMAC] | AmountBought or otherwise (See 13 NMAC 3.3.15) [now 13.3.3.15 NMAC] | AmountSold or otherwise (See 13 NMAC 3.3.15) [now 13.3.3.15 NMAC] | Nature OfOwnership (See 13 NMAC 3.3.16) [now 13.3.3.16 NMAC] | AmountOwned beneficially at end of month (See 13 NMAC 3.3.15) [now 13.3.3.15 NMAC] |
REMARKS: (See 13 NMAC 3.3.17) [now 13.3.3.17 NMAC]
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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 § 13.3.3.20