Vermont Statutes Title 8. Banking and Insurance, § 5033. Records of surplus lines broker

(1) amount of the insurance and perils insured;

(2) brief description of property insured and its locations;

(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 its terms;

(7) name and post office address of the insured;

(8) name and post office address of the insurer;

(9) name and post office address of brokerage house, if applicable, and name of licensed individual producer with whom business was placed;

(10) amount collected from the insured; and

(11) other information as may be required by the Commissioner.