1. (a) Any person engaged in business as an insurance agent or broker who accepts compensation for arranging, directing, or performing services in connection with a premium financing agreement shall disclose in writing to the insured prior to the execution of the premium finance agreement the amount of compensation such insurance agent or broker is to receive from the premium financer on account of that premium finance agreement.

2. (b) The disclosure required under subsection (a) shall be made in the following form:

   STATEMENT OF COMPENSATION TO BE PAID TO INSURANCE AGENT OR BROKER BY LENDER

   This statement is required by provisions of California Insurance Code Section 778.2.

3. 1. Name of Insured:

   1. 2. Last of Financed Policies and Amount of Premium Financed on each Policy:

      $

      $

      $

      Total

      $

   2. 3. Name and Address of Premium Financer (lender):

   3. 4. Gross Finance Charge for Financing the Above Premiums:

      $ __________

      $ _________________________

   4. 5. Total compensation to be received by the undersigned agent or broker from the lender by reason of the premium agreement relating to the above premiums (if compensation is contingent state the maximum compensation payable under any contingency):

      $

      Dated:

      (Insurance Agent or Broker)

4. (c) In lieu of the foregoing separate disclosure statement, said information may be contained in the premium finance agreement or other document, provided the premium finance agreement or other document contains all of the information set forth above and is signed by the insurance agent or broker.

Note: Authority cited: Section 778.2(b), Insurance Code.

History

1. New Article 6 (§ 2185) filed 7-19-72; effective thirtieth day thereafter (Register 72, No. 30).