1. (a) Name of insurer.
2. (b) Policy or certificate number.
3. (c) Name of insured and of purchaser.
4. (d) Effective and termination dates.
5. (e) Kind of coverage.
6. (f) Amount of gross premium.
7. (g) Amount of commission.
8. (h) Amount of net premium.
9. (i) Date of cancellation.
10. (j) Amount of gross return premium and disposition thereof.
11. (k) Any addition or reduction in original premium by reason of endorsement.
12. (l) Names of persons to whom commissions are paid or allowed and the amount to each.

Every licensed dealer or dealer's subsidiary shall maintain, separate from the records of other business transactions, a ledger, book or card record of insurance business transacted under the authority of his license, which shall set forth at least the following information:

History

1. Amendment filed 9-5-61; designated effective 1-1-62 (Register 61, No. 18).