• WC-402 (7/04) Self-Insurer Application Packet 

• WC-402A (2/06) Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form) 

• WC-402G (8/05) Group Self-Insurer Application Packet 

• WC-402GR (1/04) Group Self-Insurer Application (fill-in form) 

• WC-404 (1/04) Service Company Application (fill-in form) 

• WC-650 (3/05) - Self-Insured Group Notice of Acceptance of Membership (fill-in form) 

• WC-651 (3/05) - Notice of Termination of Membership (fill-in form) 

• Letter of Credit/Memorandum of Understanding (8/08) (fill-in form) 

• Michigan Continuous Surety Bond (12/03) 

• Michigan Certificate of Specific/Aggregate Excess Liability Insurance (1/04) 

• Self-Insurer's Claims Transfer Agreement 

• Individual Self-Insured Employer List

• Active Self-Insured Group List

• Service Company List

• Self-Insured Division Information