Automatic Payment Form

Purpose of form: Provides a format for automatic payments on your policy.



Purpose of form: Federal requirement for Taxation and Revenue purposes.


Insurer Direct Premium Request Form – Updated Form Coming Soon

Purpose of form: A form for New Mexico licensed insurers to report the total direct premiums written in New Mexico for accident and health insurance for calendar year 2018.


Pool Termination Request

Purpose of form: A form to terminate Pool coverage.