New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 3 - INSURANCE SECURITIES
Part 4 - PROXIES, CONSENTS AND AUTHORIZATIONS OF DOMESTIC COMPANIES
Section 13.3.4.20 - SCHEDULE B - INFORMATION TO BE INCLUDED IN STATEMENTS FILED BY OR ON BEHALF OF A PARTICIPANT (OTHER THAN THE ISSUER) IN A PROXY SOLICITATION IN AN ELECTION CONTEST
Universal Citation: 13 NM Admin Code 13.3.4.20
Current through Register Vol. 35, No. 18, September 24, 2024
A. Issuer: State the name and address of the issuer.
B. Identity and background: State the following:
(1) Your name and
business address.
(2) Your present
principal occupation or employment and the name, principal business and address
of any corporation or other organization in which such employment is carried
on.
(3) Your residence
address.
(4) Information as to all
material occupations, positions, offices or employments during the last ten
(10) years, giving starting and ending dates of each and the name, principal
business and address of any business corporation or other business organization
in which each such occupation, position, office or employment was carried
on.
(5) State whether or not you
are or have been a participant in any other proxy contest involving this
company or other companies within the past ten (10) years. If so, identify the
principals, the subject matter and your relationship to the parties and the
outcome.
(6) State whether or not,
during the past ten (10) years, you have been convicted in a criminal
proceeding (excluding traffic violations or similar misdemeanors) and, if so,
give dates, nature of conviction, name and location of court, and penalty
imposed or other disposition of the case. A negative answer to this requirement
need not be included in the proxy statement or other proxy soliciting
material.
C. Interest in securities of the issuer:
(1) State the amount of each class of
securities of the issuer which you own beneficially, directly or
indirectly.
(2) State the amount of
each class of securities of the issuer which you own of record but not
beneficially.
(3) State with
respect to all securities of the issuer purchased or sold within the past two
(2) years, the dates on which they were purchased or sold and the amount
purchased or sold on each such date.
(4) If any part of the purchase price or
market value of any of the securities specified in 13 NMAC 3.4.20.3.3 [now
Paragraph (3) of Subsection C of 13.3.4.20 NMAC] is represented by funds
borrowed or otherwise obtained for the purpose of acquiring or holding such
securities, so state and indicate the amount of the indebtedness as of the
latest practicable date. If such funds were borrowed or obtained otherwise than
pursuant to a margin account or bank loan in the regular course of business of
a bank, broker or dealer, briefly describe the transaction, and state the names
of the parties.
(5) State whether
or not you are a party to any contracts, arrangements or understandings with
any person with respect to any securities of the issuer including but not
limited to joint ventures, loan or option arrangements, puts or calls
guarantees against losses or guarantees of profits, division of losses or
profits, or the giving or withholding of proxies. If so, name the persons with
whom some contracts, arrangements or understandings exist and give the details
thereof.
(6) State the amount of
securities of the issuer owned beneficially directly or indirectly, by each of
your associates and the name and address of each such associate.
(7) State the amount of each class of
securities of any parent, subsidiary or affiliate of the issuer which you own
beneficially directly or indirectly.
D. Further matters:
(1) Describe the time and circumstances under
which you became a participant in the solicitation and state the nature and
extent of your activities or proposed activities as a participant.
(2) Describe briefly, and where practicable
state the approximate amount of any material interest, direct or indirect, of
yourself and of each of your associates in any material transactions since the
beginning of the company's last fiscal year, or in any material proposed
transactions, to which the company or any of its subsidiaries or affiliates was
or is to be a party.
(3) State
whether or not you or any of your associates have any arrangement or
understanding with any person:
(a) with
respect to any future employment by the issuer or its subsidiaries or
affiliates; or
(b) with respect to
any future transactions to which the issuer or any of its subsidiaries or
affiliates will or may be a party.
(c) If so, describe such arrangement or
understanding and state the names of the parties thereto.
E. Signature: The statement shall be dated and signed in the following manner:
I certify that the statements made in this statement are true, complete, and correct, to the best of my knowledge and belief.
_______________________________________________________________
(Date) (Signature of participant or authorized representative)
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