North Carolina General Statutes Chapter 58. Insurance § 58-21-75. Records of surplus lines licensee

(1) Amount of the insurance and perils insured;

(2) Brief description of the property insured and its location;

(3) Gross premium charged;

(4) Any return premium paid;

(5) Rate of premium charged upon the several items of property;

(6) Effective date of the contract, and the terms of the contract;

(7) Name and address of the insured;

(8) Name and address of the insurer;

(9) Amount of tax and other sums to be collected from the insured;

(10) Identity of the producing broker, any confirming correspondence from the insurer or its representative, and the application; and

(11) Copy of the compliance agreement.