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Each subsidiary or affiliate company of a private applicant must file a separate application to become self-insured. SELF-INSURED EMPLOYER'S APPLICATION to ADD a SUBSIDIARY.Submit the form to BWC in one of the following ways. I am an employer with multiple subsidiaries. Would my subsidiaries be covered under the same self-insurance authority as the parent company? 1) Completed Form LS-271, Application for Self-Insurance. A separate application must be completed under each Act for each separately incorporated subsidiary. How do I go about adding a subsidiary company to our self-insurers program? Example – Company coverage list. Are to be excluded from the Virginia Certificate of Self-.