27 CAR § 30-182. Form of certificate

The form of the certificate of insurance, which will be referred to as an SR-22 form, shall include but shall not be limited to the following items: (1) Name and current address of insured; (2) Policy number; (3) Effective date of policy; (4) Specify whether an owner’s or operator’s policy; (5) If owner’s policy: (A) Model year; (B) Name of manufacturer; (C) Model; (D) Body type; and (E) Vehicle identification number (VIN); (6) Date of issuance; (7) Name of insurance company; and (8) Signature of authorized representative.