The form of the certificate of insurance, which will be referred to as an SR-22 form, shall include but shall not be limited to the following items:

1. (1) Name and current address of insured;
2. (2) Policy number;
3. (3) Effective date of policy;
4. (4) Specify whether an owner’s or operator’s policy;

5. (5) If owner’s policy:

   1. (A) Model year;
   2. (B) Name of manufacturer;
   3. (C) Model;
   4. (D) Body type; and
   5. (E) Vehicle identification number (VIN);
6. (6) Date of issuance;
7. (7) Name of insurance company; and
8. (8) Signature of authorized representative.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "-27-19-712 FORM OF CERTIFICATE"