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(Submit one completed copy). CONFIDENTIAL. The application is to be completed in full and accompanied by: (1).Self-insurer's latest audited annual financial report;. Self-Insurance employers provide workers' comp insurance benefits directly to the injured worker. Insolvent Self-Insurers. Do the preceding companies have a working knowledge of the Utah Workers' Compensation Act and Rules? Yes No. (Please include curriculum vitae). Self Insurance Bond. Self-Insurance Division, in conjunction with the Employer's Initial Application for Self-Insurance. (Please print or type all information.