Alberta WCB Account Set Up for paid Customers Alberta WCB Account Set Up for paid Customers "*" indicates required fields Step 1 of 7 14% Alberta WCB Account Set UpOur accountant will evaluate this form once you fill it out, pay for it, and submit it before filing it with the WCB authorities. We will get in touch with you if any details are missing.Make sure you fill out this form completely & accurately. Within five to ten business days of receiving this form, WCB will get in touch with you directly.Did You Register with us?*YesNoYour order numberBusiness Name (accurate)*If Known, CRA Business NumberYour business type* Corporation Individual/Proprietorship Partnership Limited/Incorporated Other Write your business type*Have you or this business organization ever been registered with WCB-Alberta under the above name or any other business name*YesNoWCB-Alberta Account Number(s)Name on previous WCB-Alberta account:*Have you purchased this business?*YesNoPrevious Business Name:*Date Purchased* MM slash DD slash YYYY Previous Owner Contact Name(s):*Phone Number:* Business AddressDelivery ModeGround DeliverySSRRPO BoxMRPO Box or Route Number:*Actual physical location of operations Same as billing address Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Contact DetailsApplicant's First Name*Applicant's Last Name*PositionOwner/DirectorLegal RepresentativeLegal RepresentativeEmployeeEmployee RepresentativeOtherRegular Phone NumberPlease provide your emailConfirm Your email Business Hiring ActivityDo you hire workers and/or subcontractors?YesNoEstimated number of workers (excluding directors)Start date of first workerMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Estimated total payment to workers (excluding directors)Seasonal Work: Do you operate for part of the year?YesNoTypical starting month for seasonal workWrite Only Month Typical ending month for seasonal workWrite Only Month Are you an independent owner/operator of heavy equipment or truck(s)?YesNOPlease list make, year, model, and/or serial number(s):Who is the registered owner of the heavy equipment or truck(s)?Do you own and/or lease any other equipment or assets?YesNoPlease list make, year, model, and/or serial number(s):Who is the registered owner of the heavy equipment or truck(s)?Do you perform work outside of Alberta?YesNoPlease list location(s):Whether a personal or business bank account, what is the name of the bank used for business?What is the location of the bank used for business? Company OperationsProvide a description of your operations including activities performed, products developed and services provided.Provide a list of direct competitors. Reviewing competitors can assist when classifying a new business. Personal CoverageDirectors, owners and partners are not automatically covered under the Workers' Compensation Act. Personal Coverage must be requested. Do you want to add personal coverage? Yes No Personal coverage holders' detailsFirst nameLast nameDate of Birth (YYYY/MM/DD)Coverage Amount ($) Add RemoveDeclaration of Accuracy* Yes, I certify the following By submitting this form, I certify that I am authorised to complete it and that, to the best of my knowledge and belief, the information provided is true and accurate. I am aware that the Alberta Workers' Compensation Act allows for administrative fines or criminal charges to be levied against those who intentionally give the Board inaccurate or misleading information.
