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Checklist for a workers compensation Self-Insurance Group (SIG) to merge with another SIG engaged in the same or similar type of business, PDF, English. A complete response to all applicable items is required.The following checklist is to be completed and submitted with the application. The self-insuring employer must post a copy of the Certificate of Employer's Right to Pay Compensation. Self-Insurer Applicant: Application for workers' disability compensation self-insured authority is made on Form WC-402. Questions 1through 10 must be completed. Time a complete rate or rule filing is received until the. New York State Workers Compensation Board ("Held") (Sup. Employer or the employer is a member of a group self-insurance plan as defined in subsection (1) of Section 4a. Completing Form WC-26: Section A a.