Information in schedule B shall include, among other things:

(1) The name and address of the insurer;
(2) Detailed information about the participant;
(3) The participant’s interest in the stock of the insurer;
(4) A description of the time and circumstances in which the participant became involved with the solicitation and the nature and extent of the activities or proposed activities of the participant; and
(5) The date and signature of the participant.