Canada WSIB Registration Order Form

Complete and Send Your WSIB Registration Information

This information is being collected for the purposes of register a business with the Canada Workers Compensation Board, in accordance with the Alberta Workers Compensation Legislation.

The Government filing time for a Canada Workers Compensation is 6 days

All orders are made through our secured pages for your protection. We use the same level of security as Canadian banks. This offers you the highest available level of protection. Be sure to provide a valid email address - this will be our primary means of communication with you during the registration process.

Province where do you want to register for the WSIB:	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon
Your Type of Business	Sole Proprietorship Partnership Corporation
Business Name:
If any, trade name:
If Corporation: Incorporation Number:
If Corporation: Incorporation Date:
If Corporation: Jurisdiction of Incorporation:
Business Address
Registered Office Address:
City:
Province:
Postal Code:
Business Telephone Number:
Business Fax Number:
Website Address:
Email:
Section A: Should You Register?
Do you currently hire workers, or (sub)contrators:	Yes No
If you have answered yes, how many workers do you generally have?:
Section B: Previous Registration
Do the owner(s), partners or executive officer(s) have, or have they previously had, an account with the WSIB?:	Yes No
Legal Name:
Address:
City:
Province:
Postal Code:
Telephone:
WSIB Account Number:
Section C: Employer Name(s) and Identification
Business Legal Name:
Type of Ownership:	Sole Proprietorship Partnership Corporation Other
Trade Name:
Language Preference:	English French
CCRA No.(Revenue Canada):
Bank Name:
Branch:
Section D: Address(s)
Please provide the physical location where the employer is carrying on business
Address:
City:
Province:
Postal Code:
Telephone:
Payroll Address
Payroll Address same as Business address
If no, please provide the payroll address
Address:
City:
Province:
Postal Code:
Telephone:
Section E: Business Activity
Describe your business activity, including equipment or machinery used and materials contained in your product
Business Activity Description
Date Help First Employed:
First employee estimated insurable earnings for the current calendar year
Second Business Activity
Second Business Activity Description
Date Help Second Employed:
Second employee estimated insurable earnings for the current calendar year
Third Business Activity
Third Business Activity Description
Date Help Third Employed:
Third employee estimated insurable earnings for the current calendar year
If there are more than three business activites, please complete here:
If there is more than one business activity, do you maintain segregated payrolls for each business activity?:	Yes No
Please provide the trade names and business activities of three competitors
Competitor 1
Name:
Business Activity:
Competitor 2
Name:
Business Activity:
Competitor 3
Name:
Business Activity:
Section F: Owner/Executive Details
Please provide the following details about the owner, managing partner, or chief executive officer.
Name:
Middle Name:
Last Name:
Date of Birth:
Title:
Address:
City:
Province:
Postal Code:
If the employer has more partner(s) or executive officer(s) than the one individual show above, please write here:
Section G: Associated Employer(s)
Does the employer have an associated relationship with one or more other employers:	Yes No
If yes, does the employer have any business dealings with the associated employer(s)?:	Yes No
If you have answered yes to both these questions, please provide the name and address of the associated employer:
Section H: Certification
Name:
Telephone Number
Date Completed:
Payment Information
Method Of Payment:	Interac Credit Card
CorporateRegistries.ca accept Payments from Its customers through INTERAC EMAIL MONEY TRANSFER or CREDIT CARD Interac Email Money Transfers are a simple, convenient, and secure way to send your payment directly from your bank account without sharing any personal or financial information. All you need is access to online banking through a participating financial institution: BMO Bank of Montreal, CIBC, Prospera Credit Union, RBC Royal Bank of Canada, Scotiabank, TD Canada Trust. Our email address for interac payments is: interact_emt@corporateregistries.ca To pay with Interac Email Money Transfer: * Login to your bank online banking * Locate Transfer/Payment menu options * Specify a recipient by entering our email address: interact_emt@corporateregistries.ca * Fill in the Interac Email Money Transfer information (dollar amount, account from which to withdraw the funds, a security question that only the recipient will know the answer to and optional personal message) * Follow instructions to confirm the information and complete the transfer If Paying By Credit card, You will have the option on the Payment Page to Complete your Payment by Credit Card using Google Checkout.
Additional information
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If print advertising which one?:
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