N.M. Admin. Code § 13.7.2.9
The following form shall be used when the borrower or purchaser, after signing the form required by 13 NMAC 7.2.8 [now 13.7.2.8 NMAC], nevertheless chooses to authorize the lender to purchase the required coverages:
AUTHORIZATION FOR LENDER TO OBTAIN INSURANCE
Although (name of lender) will accept suitable insurance policies to protect our respective interests in the property used as security for the loan through my choice of any agent of any insurance company licensed in New Mexico, I have elected to authorize (name of lender) to purchase insurance coverage for our joint protection, and I hereby authorize (name of lender) to obtain from any insurance company licensed in New Mexico or any of its agents the following insurance polices, until such time as I rescind this authorization or supply a substitute or replacement policy:
DECLARATIONS FOR POLICIES OF INSURANCE
Name of Purchaser or Borrower:_______________________________________________________________
Address:___________________________________________________________________________________
Name of Mortgagee/Lienholder:_________________________________________________________________
Address:____________________________________________________________________________________
Name of Contingent Beneficiary, if any:___________________________________________________________
Address:____________________________________________________________________________________
Name of Insurance Company:____________________________________________________________________
COVERAGESPREMIUMS
____________ $_____________
____________ $_____________
____________ $_____________
____________ $_____________
____________ $_____________
TOTAL $_____________
N.M. Admin. Code § 13.7.2.9