Section 177D. An insurance adviser who furnishes any advice or counsel as such adviser, makes any recommendation or gives any information except under the terms of a previously executed written contract conforming to the preceding section and in full force and effect shall thereupon, in every case, give to the recipient thereof a statement in writing, signed by him, in a form currently approved by the commissioner, specifying the advice, counsel, recommendation or information given, and a receipt, in a form currently approved by the commissioner, for the fee paid to him, or a statement, in a form currently approved by the commissioner, of the fee to be received by him therefor. Whoever violates any provision of this section shall be punished by a fine of not less than fifty nor more than five hundred dollars.