N.M. Code R. § 13.9.20.12
A. An insurer is responsible for compliance with this rule. If a violation occurs, either because of the action or inaction of the insurer or its insurance producer, the superintendent may order:
B. Any applicable penalty under Section 59A-1-18 NMSA 1978 for a violation of this rule may be reduced or eliminated according to a schedule adopted by the superintendent if corrective action for the consumer was taken promptly after a violation was discovered or the violation was not part of a pattern or practice.
APPENDIX A
CONSUMER DISCLOSURE
CONSUMER INFORMATION
First Name: _____________________________________ Last Name: ____________________________________
INSURANCE PRODUCER INFORMATION
First Name: _____________________________________ Last Name: ____________________________________
Business/Agency Name: ________________________________________ Website: _________________________
Business/Mailing Address: _______________________________________________________________________
Business Telephone Number: ____________________________ Email Address: ____________________________
National Producer Number (“NPN”) ____________________________ Domicile State: ______________________
What Types of Products Can I Sell You?
I am licensed to sell annuities to You in accordance with state law. If I recommend that You buy an annuity, it means I believe that it effectively meets Your financial situation, insurance needs and financial objectives. Other financial products, such as life insurance or stocks, bonds and mutual funds may also meet Your needs.
I offer the following products:
Fixed or Fixed Indexed Annuities
Variable Annuities
Life Insurance
I need a separate license to provide advice about or to sell non-insurance financial products. Below, I have checked any non-insurance financial products that I am licensed and authorized to provide advice about or to sell.
Mutual Funds
Stocks/Bonds
Certificates of Deposit
Whose Annuities Can I Sell to You?
I am authorized to sell:
Annuities from only one insurer
Annuities from two or more insurers
Annuities from two or more insurers, although I primarily sell annuities from: _______________________
How I am Paid for My Work?
It is important for You to understand how I am paid for my work. Depending on the particular annuity You purchase, I may be paid a commission or a fee. Commissions are generally paid to Me by the insurer while fees are generally paid to Me by the Consumer (You). If You have questions about how I am paid, please ask Me.
Depending on the annuity You buy, I will or may be paid cash compensation as follows:
Commission, which is usually paid by the insurer or other sources. If other sources, they come from: _______________________________.
Fees (such as a fixed amount, an hourly rate, or a percentage of Your payment), which are usually paid directly by the Consumer.
Other: ____________________________________________________________________________.
If you have questions about the above compensation I will be paid for this transaction, please ask me.
I may also receive other indirect compensation resulting from this transaction (sometimes called “non-cash” compensation), such as health or retirement benefits, office rent and support, or other incentives from the insurer or other sources.
By signing below, You acknowledge that You have read and understand the information provided to You in this document.
__________________________________________
Consumer Signature
______________________
Date
__________________________________________
Insurance Producer Signature
______________________
Date
APPENDIX B
CONSUMER REFUSAL TO PROVIDE INFORMATION
Do Not Sign Unless You Have Read and Understand the Information in this Form
Why are You being given this form?
You are buying a financial product: an annuity.
To recommend a product that effectively meets Your needs, objectives and situation, the agent, broker or insurer needs information about You, Your financial situation, insurance needs and financial objectives.
If You sign this form, it means You have not given the agent, broker or insurer some or all the information needed to decide if the annuity effectively meets Your needs, objectives and situation. You may lose protections under the New Mexico Insurance Code if You sign this form or provide inaccurate information.
Statement of Purchaser:
· I REFUSE to provide this information at this time.
· I have chosen to provide LIMITED information at this time.
__________________________________________
Consumer Signature
______________________
Date
APPENDIX C
Consumer Decision to Purchase an Annuity NOT Based on a Recommendation
Do Not Sign This Form Unless You Have Read and Understand It.
Why are You being given this form?
You are buying a financial product: an annuity.
To recommend a product that effectively meets Your needs, objectives and situation, the agent, broker or insurer has the responsibility to learn about You, your financial situation, insurance needs and financial objectives.
If You sign this form, it means You know that you are buying an annuity that was not recommended.
Statement of Purchaser:
I understand that I am buying an annuity, but the agent, broker or insurer did not recommend that I buy it. If I buy it without a recommendation, I understand I may lose protections under the New Mexico Insurance Code.
__________________________________________
Consumer Signature
______________________
Date
__________________________________________
Insurance Producer Signature
______________________
Date
History of 13.9.20 NMAC: [RESERVED]