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Two completed TDI-15 forms. 2. A copy of your self-insured plan. 3.Have the employer complete Part B, Employer's Statement. Mail the form to employer's TDI insurance company if the employer is not self-insured. Download INSTRUCTION SHEET FOR FORM TDI-15 TDI SELF-INSURER'S PLAN CERTIFICATION AND AGREEMENT – Labor and Industrial Relations (Hawaii) form. A private employer who is approved for a certificate of authority to selfinsure is called a certified selfinsurer (CSI). Listing of All Texas Department of Insurance Forms. TDI Form Number, Description, File Format, Language. After your plan is approved, you will receive forms and instructions for Semi-Annual and. Annual Reports of Temporary Disability Benefits.