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The self-insuring employer must post a copy of the Certificate of Employer's Right to Pay Compensation. To be authorized to self-insure, you must submit a completed.A complete response to all applicable items is required. The following checklist is to be completed and submitted with the application. Certificate of Authority Application for a Captive Insurance Company, either a Texas start up or a company wishing to redomesticate to Texas, PDF, English. Properly submitted application (all information complete and on an original form) received at least sixty (60) days prior to the desired effective date. Application for Self-Insurance - Disability Benefits Law (Form DB-150); Foundation documents (i.e. Cancellation of an individual self-insured's certificate of authority. § 4904 (relating to unsworn falsification to authorities). GUIDELINES FOR SELF-INSURANCE FOR PRIVATE EMPLOYERS.