STATE OF NEW MEXICO WORKERS COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, JOINT WAIVER OF DISQUALIFICATION AND WAIVER OF SERVICE OF PROCESS _______________________, appearing for the Worker, and ____________________________, appearing for the Employer/Insurer jointly waive the right to disqualify a judge in the above captioned cause as provided under New Mexico Workers Compensation Administration Rule 4.4.12.2.3. I, ________________________, appearing for the Worker/Employer/Insurer waive my right to the service of process of the _________________________________ in the above captioned cause at: ___________________________________ ___________________________________ ___________________________________ Pursuant to Rules of Civil Procedure for the District Courts of New Mexico Rule 1-004. >>>> 2 ________________________ Signature of the person waiving service of process ________________________ Relationship to Entity/ Authority to Receive Service of Process ________________________ Date of Signature _____________________________ ____________________________________ Counsel for Worker/Pro Se Counsel for Employer ______________________________ ____________________________________ ______________________________ ____________________________________ ______________________________ ____________________________________