1. (a) The following information concerning the applicant:

   1. (1) name of the applicant;
   2. (2) Federal employer's number;

   3. (3) coverage for which self-insurance is requested:

      1. (i) property damage;
      2. (ii) bodily injury;
   4. (4) amount of reserves set aside to meet future claims;
   5. (5) manner in which claims are investigated and adjusted;
   6. (6) number of accidents in last two years;
   7. (7) number of claims and amounts;
   8. (8) number of settlements and amounts;
   9. (9) number of judgments open and unsatisfied; and
   10. (10) period of time covered by certificate of self-insurance.

2. (b) The following information concerning each snowmobile to be covered by self-insurance:

   1. (1) year of manufacture;
   2. (2) make of snowmobile;
   3. (3) identification number; and
   4. (4) registration number.
3. (c) An affidavit attesting to the truth of the above information, signed by the chief fiscal officer of the applicant and acknowledged by a notary public.

The application for a certificate of self-insurance shall contain: