The affirmation of financial responsibility required under Sections 66-5-208, 66-5- 225 and 66-5-226 N.M. Stat. Ann. shall be in a form prescribed by the department and shall require an applicant to provide such information as may be required by the department. If a person affirms the existence of a motor vehicle insurance policy, the affirmation form shall require him to report at least the name of the insurer issuing the policy and the policy number.