Each surplus line broker shall on or before the first day of April of each year file with the Insurance Commissioner a verified statement of all surplus line insurance transacted by him during the preceding calendar year. The statement shall be on a form prescribed and furnished by the Insurance Commissioner and shall show:

1. 1. Gross amount of each kind of insurance transacted,
2. 2. Aggregate gross premiums charged,
3. 3. Aggregate of return premiums paid to insureds,
4. 4. Aggregate of net premiums, and
5. 5. Such additional information as may reasonably be required by the Insurance Commissioner.

Laws 1957, HB 501, p. 259, § 1114.