(a) At its top, the words PREMIUM FINANCE AGREEMENT in at least ten point bold type; and

(b) A notice in at least eight point bold type, reading as follows: NOTICE: 1. Do not sign this agreement before you read it or if it contains any blank space. 2. You are entitled to a completely filled in copy of this agreement. 3. Under the law, you have the right to pay off in advance the full amount due and under certain conditions to obtain a partial refund of the service charge. 3. A premium finance agreement shall:

(a) Contain the name and place of business of the insurance agent or broker, if any, negotiating the related insurance contract, the name and residence or the place of business of the insured as specified by him, the name and place of business of the premium finance agency which is to hold or acquire the agreement and to which instalment or other payments are to be made, a description of the insurance contract, the premiums for which are advanced or to be advanced under the agreement, and the amount of the premiums for such insurance contract; and

(b) Set forth the items required to be disclosed by the act of congress entitled "Truth in Lending Act" and the regulations thereunder, as such act and regulations may from time to time be amended. 4. No premium finance agreement shall be signed by an insured when it contains any blank space to be filled in after it has been signed; however, if any insurance contract, the premiums for which are advanced or to be advanced under the agreement, has not been issued at the time of its signature by the insured and it so provides, the name of the authorized insurer by whom such insurance contract is issued and the policy number and the due date of the first instalment may be left blank and later inserted in the original of the agreement after it has been signed by the insured.