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Three years of certified, independently audited financial statements. Acceptable credit rating for three full calendar years prior to application.Read all instructions before completing this application. Answer all questions. A complete response to all applicable items is required. The following checklist is to be completed and submitted with the application. Please completely fill out the WC-21 APPLICATION FOR SELF-INSURANCE AUTHORIZATION FORM. The Delivery Information section below lists various delivery options. An employer who wishes to self-insure on an individual basis for workers' compensation benefit must meet the following criteria to apply:. Attached is an application for self-insurance of workers' compensation liability.