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:____________________________________________________________________

COVERAGES PREMIUMS

____________ $_____________

____________ $_____________

____________ $_____________

____________ $_____________

____________ $_____________

TOTAL $_____________

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

HISTORY OF 13.7.2 NMAC:

Pre-NMAC History: The material in this rule was originally filed with the State Records Center as part of ID 67-1, New Mexico Official Administrative Rules and Regulations Code, filed 12/1/67; the original effective date of the rule was May 10, 1966.

History of Repealed Material: [RESERVED]