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SELF-INSURER'S STATEMENT OF OUTSTANDING LOSSES. Form WC-83: Statement of Outstanding Losses, as of December 31 of the reporting year.1) Completed Form LS-271, Application for Self-Insurance. EXCEPTION: A Certificate to Self-Insure that is revoked for three full years is not required to submit this employment and wage information. A complete and final actuarial review containing a valuation of losses valued at the required confidence levels for all completed plan years. The Board may reject discount rates considered to be unreasonable. A certified audit of a group self-insurer's fund must be filed within 90 days after the end of the group's self-insurer's fiscal year. We have audited the financial statements of the SelfInsurers' Security Fund (Fund), Funds. This liability is considered unfunded if a surety bond has been posted equal to all or a portion of the total amount of the contingent liability. 6. Liabilities in the most recent financial statement. Subp. 7. Deficit.