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In order to terminate your self-insurance authority, please submit the following to the Division:
- A formal notification from the self-insured employer who wishes to voluntarily terminate its self-insurance authority;
- Detailed loss runs from the first date of self-insurance authority through the termination request date;
- Self-Insurer′s past two years of audited financials; and
- Copy of certificate of insurance for the replacement coverage.
- The Division may require additional information.
