NEW MEXICO DEPARTMENT OF WORKFORCE SOLUTIONS 
                    PO Box 1928, Albuquerque, New Mexico  87103 * (505) 841-8576 

                                   CERTIFICATE OF DEPOSIT 

EMPLOYER NAME:_________________________________________          ACCOUNT #______________ 

BANK:________________________________________________            CERTIFICATE NO.______________ 

CERTIFICATE AMT._____________                                    MATURITY DATE_______________ 

In  consideration  of  Section  51-1-13  NMSA  1978  of  the  New  Mexico  Unemployment  Compensation  Law,  hereby 
assigns all rights, interest, and title to the Certificate of Deposit described above, over to the New Mexico Department 
of  Workforce  Solutions.  Earned  interest  shall  be  paid  directly  to  employer,  however,  the  Department  is  entitled  to 
negotiate this instrument, or any portion thereof, in the event employer fails to pay the required reimbursable benefit 
charges, when due.  

The Department shall retain possession of the Certificate of Deposit and shall return the Certificate and any interest 
earned  to  the  employer  upon  termination  of  employer's  unemployment  compensation  obligations  in  New  Mexico, 
provided that all required reports have been submitted an all reimbursable benefit charges due and potential benefit 
charges as determined by the Department have been paid. In the event the employer fails to pay reimbursable benefit 
charges due, the Department has the right to retain the entire Certificate of Deposit in full or partial payment of the 
reimbursable benefit charges due.  

This assignment will remain in effect until the Maturity Date of the Certificate of Deposit described above or upon a 
mutual release by the Department and the employer prior to the maturity Date. The bank is hereby authorized to pay 
over the proceeds of the Certificate of Deposit to the Department upon presentment and the employer hereby waives 
any and all claims against the bank for doing so.  

The bank and the employer waive the right to enforce any "Non Transferable" language on the face of the Certificate of 
Deposit and acknowledge that the New Mexico Department of Workforce Solutions will have all of the rights to the 
Certificate of Deposit of a secured party under New Mexico Law.  

The bank hereby agrees not to release any of the principal amounts to the employer, without the prior approval by the 
New Mexico Department of Workforce Solutions.  

Employer Representative: ________________________________ Bank Representative:______________________ 

                    Title: ________________________________      Title:______________________ 

Subscribed and sworn before me this ____________day of _________________, 20______. 

                                                                 Notary Public ______________________________ 
     SEAL 
                                                                 My Commission Expires_____________________ 

ES-802 O (B) 
Rev. 07/07                                                S/N