The notice that employer has become subscriber shall be filed with the board's Austin office by certified mail or in person within 30 days of the effective date of the policy and the notice must be completed in detail and shall include:
  (1) name, address, and occupation of insured;
  (2) effective date of the policy;
  (3) signature of the insurance company representative;
  (4) complete name of the insurance company;
  (5) policy number, and if notice is a rewrite of an existing policy, this information must be included on the notice;
  (6) area or location of the business;
  (7) Form 154, which shall be filed for divided risk coverage; and
  (8) the employer's federal tax identification number (effective 1987).

Source Note: The provisions of this §43.5 adopted to be effective November 20, 1977, 2 TexReg 4316; amended to be effective September 25, 1979, 4 TexReg 3230; amended to be effective November 11, 1983, 8 TexReg 4492; amended to be effective October 1, 1985, 10 TexReg 3506; amended to be effective December 21, 1987, 12 TexReg 4529.