Whenever a premium finance company executes a premium finance agreement relative to a personal or family-type policy of insurance, it shall mail or deliver to the insured a copy of the agreement as provided in subsection (c) of Code Section 33-22-8 and a written notice which clearly discloses to the insured the existence of the power of attorney contained in such agreement. The written notice shall substantially comply with the following form:

"NOTICE

Your insurance policy premiums have been financed and are payable on a monthly payment basis. If you do not pay each payment on or before the date due or within 15 days of the date due, we have the right to CANCEL your insurance policy or policies which are financed under the premium finance agreement. To avoid cancellation of your policy or policies, MAKE YOUR PAYMENTS ON TIME."