The statement shall be on forms furnished by the director and shall show:

1. (1) Gross amount of each kind of insurance transacted;
2. (2) Aggregate gross premiums charged;
3. (3) Aggregate of returned premiums paid to insureds;
4. (4) Aggregate of net premiums; and
5. (5) Additional information as required by the director.

Source: SL 1966, ch 111 , ch 11, § 17 (2).