Business Name

If Known, Enter us Order number

Your Business Name

Business Phone Number

Email address for further follow up*

Enter Email Confirm Email

Business Activities

Does your company have employees besides you?

How many employees does your company have?*

This includes your family members, occasional employees, apprentices, employees who are under contract, and independent contractors who the WSIB has decided to be your employees.

Are you a non-Ontario employer who hires workers who spend at least 11 days a year working in Ontario?*

Please describe your primary business activities. Please be specific and as accurate as possible. This will help to avoid delays in processing.*

Business Profile

On what date did you first hire workers for this activity?

Estimated insurable earnings for a full calendar year*

If known, please Enter your CRA Business Number

Employment Details

Enter Business Location Address

Street Address City ZIP / Postal Code

Business Mailing Address is Same as Location Address?*

Enter Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is the above business address your only work location?*

Enter Additional Location Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you registering WSIB as the result of a purchase of a business or bankruptcy?*

Do any owners, partners or executive officers have, or previously had, an account with the WSIB?*

Owner

Name of Owner, Partner or Executive Officer

First Last

Date of Birth*

Title

Contact Number

Authorization*

I have been given permission by the corporate body (employer) specified in this registration to submit this registration. I acknowledge that the data I have provided in this registration, which will be used to create an account, is true and complete to the best of my knowledge.

Prince Edward Island WCB Account Registration

Business Name

Business Activities

Business Profile

Employment Details

Owner

Office Address

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Business

Prince Edward Island WCB Account Registration

Business Name

Business Activities

Business Profile

Employment Details

Owner

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Business Email