WSIB Form

Your Existing Order number (if Known)
Your Business Legal Name
Business Phone Number
Your email address for further follow up*
Enter Email Confirm Email
Authorization*
- I am authorized to submit this registration on behalf of the legal entity (employer) named in this registration. I acknowledge that the information submitted in this registration is accurate and complete to the best of my knowledge and will be used to establish an account.

Does your business employ workers other than yourself?
How many workers does your business employ?*
Note: This includes: family members, occasional workers, apprentices, workers under contract and contractors determined by the WSIB to be your workers.
Are you a non-Ontario employer who employs workers who work in Ontario for 11 days or more within a calendar year?*
Please describe your primary business activities. Please be specific and as accurate as possible. This will help to avoid delays in processing.*

On what date did you first hire workers for this activity?*
Date Format: MM slash DD slash YYYY
Estimated insurable earnings for a full calendar year*
If known, please Enter your CRA Business Number (only first 9 digit)

Enter Business Location Address
Street Address City 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?*

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