No later than thirty days after the last day of each calendar quarter, every surplus lines licensee shall file with the department a report containing such information as the department may require, including: (1) The name of the nonadmitted insurer;
(2) the name of the licensee;
(3) the number of policies issued by each nonadmitted insurer;
(4) a sworn statement by the licensee with regard to the coverages described in the quarterly report that, to the best of the licensee's knowledge and belief, the licensee could not reasonably procure such coverages from an admitted insurer; and
(5) the premium volume for each nonadmitted insurer by line of business.
