Section 58-20-27 - Application for self-insurance association-Form An association proposing to self-insure its workers' compensation liability shall apply to the department for the authority to self-insure, using forms available from the department. The application shall include:
(1) The association's name;(2) The location and mailing address of the association's principal office and where its books and records are kept;(3) The name and address of each member of the association;(4) A copy of the bylaws or plan of operation adopted by the association;(5) Proof of compliance with § 58-20-28;(6) A sample copy of the agreement between the association and the members securing the payment of each member's workers' compensation liability;(7) A pro forma financial statement, on a form acceptable to the department, showing the financial ability of the association to pay the workers' compensation liability of its members; and(8) The required application fee.