The following form shall be used to give the notice of rights required by Section 59A-16-14 NMSA 1978:

FREEDOM TO CHOOSE

INSURANCE COMPANY AND INSURANCE PROFESSIONAL

The undersigned person hereby acknowledges that I have been informed by (individual’s name) on behalf of (name of lender) that, although I may be required by the seller or lender to purchase insurance to cover the property that is being used as security for the loan, I may purchase that insurance from the insurance company or agent of my choice, and cannot be required by the seller or lender, as a condition of the sale or loan, to purchase or renew any policy of insurance covering the property through any particular insurance company, agent, solicitor, or broker. I hereby acknowledge receipt of a true copy of this notice on the _____day of_____________, _____.

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(Signature of Purchaser or Borrower)

[7/1/97; Recompiled 11/30/01]