(a) Through its proper officer or agent, each licensee promptly shall notify the Commissioner of the name, title, and address of each individual the licensee desires to appoint as a representative in the State.

(b) The notice required by this section shall be:

(1) filed with the Commissioner on the form that the Commissioner provides; and

(2) accompanied by:

(i) an initial registration fee of $5; and

(ii) a statement in writing, by the appointee, that gives:

1. the appointee’s name, age, residence address, business address, present occupation, and occupation for the 5 years immediately preceding the date of the notice;

2. the names of motor clubs represented during the 5 years immediately preceding the date of the notice and where represented; and

3. any other information the Commissioner requires.