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SELF-INSURANCE APPLICATION CHECKLIST. The following items are needed to fully complete your Self-Insurance application.Application Checklist for Self-Insurance. Completed Application. A complete response to all applicable items is required. The following checklist is to be completed and submitted with the application. You must include the following documents with your renewal application: 1. A copy of your most recent certified consolidated financial statement. CLASS II SELF-INSURANCE CHECKLIST. CLASS I HAZARDOUS SELF-INSURANCE CHECKLIST.