(a) A title insurance agent who receives a portion of a premium shall disclose to each purchaser of a title insurance policy or other title insurance form the following:
(1) each shareholder, owner, or partner owning or controlling at least one percent of the agent;
(2) each shareholder, owner, or partner owning or controlling at least 10 percent of an entity that owns or controls at least one percent of the agent;
(3) each person who is not a full-time employee of the agent and who receives a portion of the premium for services performed on behalf of the agent in connection with the issuance of a title insurance form; and
(4) the amount of premium that a person disclosed in Subdivision (3) receives.
(b) The department shall prescribe the form of the disclosure required by this section.