Every certificate of insurance issued or presented in this state pursuant to a workers' compensation insurance policy shall contain the following information:
I. All states for which such statutory coverage is provided;
II. Names of all executive officers or members who are excluded, if any, pursuant to RSA 281-A:18-a, or a notation that no executive officers or members are excluded; and
III. Names of all sole proprietors or partners who have elected to be covered under the policy or a notation that no sole proprietors or partners are covered.