WSIB Online Registration for Paid Customers 1

Business Name

If Known, Enter RegiCorp 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.

WSIB Online Registration for Paid Customers