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REGISTRATION FORM
for Workers Safety & Insurance Board (WSIB) in Ontario.

You can use this form to register for WSIB in Ontario. Please note that we are a private company that provides complete business support to entrepreneurs in Canada, including WSIB registration. Our fee for registration is $50, plus applicable taxes. If you wish to do registration on your own, you need to contact the appropriate government department directly.

Please download and print the Consent form. This form is required for registering WSIB account.
Download the Consent Form in pdf format, to be signed and faxed to us at
416-226-0013.

Please note, if you are registering WSIB account for a corporation, you must fax or e-mail to us your Articles of Incorporation.

If you have any questions, please contact us at (416) 226-2921 or toll free at
1-877-226-2921

1.	Please enter the order date: * Required Information
		-- YYYY/MM/DD *

2.	Have you ever had a WSIB account before?
		Yes No *
	If yes, enter your old WSIB number here

	Do you have employees or sub-contractors at this time or will you have them within next 14 days?	Yes No *

3.	Specify the exact name of your business as listed on the registration documents: (if you are operating under your own name, write your first and last name below)


4.	**Business Address ***
	Street
	City
	Province
	Postal Code
	Business Phone #
	Business Fax #

5.	What type of business do you have? *
	Sole Proprietorship Partnership Corporation

6.	Do you have a federal business number?	Yes No *
	If yes, enter your existing number here

7.	What is the name of your Bank?
	Branch address

8.	Clearly describe your major business activities:

a.	*
	Date when you hired your workers for this activity:	-- YYYY/MM/DD *
	Estimated Annual earning for all workers performing this activity:	*in Dollars*


b.	*
	Date when you hired your workers for this activity:	-- YYYY/MM/DD *
	Estimated Annual earning for all workers performing this activity:	*in Dollars*

c.	*
	Date when you hired your workers for this activity:	-- YYYY/MM/DD *
	Estimated Annual earning for all workers performing this activity:	*in Dollars*

9.	Information for the Sole Owner, Managing Partner or Director.
	Sole Owner Partner Director *
	First Name	*
	Last Name	*
	Street Address	*
	Address (cont.)
	City	*
	Province	*
	Postal Code	*
	Country	*
	Social Insurance Number (Mandatory for Registration)	*
	Date of Birth (Mandatory for Registration)	yyyy/mm/dd *
	Work Phone	*
	Home Phone	*
	FAX
	E-mail	*

10.	Agent's Contact Information
	Complete this section only if acting on behalf of the owner
	First Name
	Last Name
	Street Address
	Address (cont.)
	City
	State/Province
	Zip/Postal Code
	Country
	Work Phone
	Home Phone
	FAX
	E-mail

	How did you hear about us?
	Sign up for our Newsletter?	Yes No


11.	BILLING
	If documents are to be delivered, the delivery address must be the same as the billing address on the credit card.

	Credit Card	*
	Cardholder Name	*
	Card Number	*
	Expiration Date	*
	If you do not have a credit card, you can make the payment by cheque, by PayPal, make a deposit to our bank account or make a bill payment at your bank, please contact us for more information at 416-226-2921 or toll free at 1-877-226-2921

12.	Delivery options:
	You will be notified by telephone once your WSIB account is registered.
	Also, you will receive a confirmation of your registration directly from the WSIB office via mail.


13.	Please write your comments below.



Business Development Centre as a registering agent must follow the instructions provided by the client. Please be advised that the onus is on the client to ensure the information supplied to us and recorded in the WSIB system is accurate, up-to-date and in compliance with the applicable laws. Please review the documents carefully upon receipt to ensure the accuracy of the information. If a document contains any discrepancy, please advise our office immediately.

Before you submit this order form to us, please check all information for accuracy. Please carefully review our refund policy below. No fees paid to the governments, or to any agencies accepting money on behalf of the governments, can be refunded under any circumstances. All fees and money paid by the customer to the Business Development Centre are fully earned once the order is submitted. No refunds are available once you submit the order. If you decide to cancel the order, you will be entitled only to receive a refund for government filing fees that have not been paid to the government or it’s agents. Once government fees have been paid, no refund is possible. This policy is enacted in order to prevent fraudulent orders.

14.	Authorization
	Please select the button ( ) below to Authorize this order.
I, hereby confirm that the above information, supplied by me is correct in every respect. Furthermore, I fully understand and agree with your refund policy, specifically that "No fees paid to the governments, or to any agencies accepting money on behalf of the governments, can be refunded under any circumstances. All fees and money paid by the customer to the Business Development Centre are fully earned once the order is submitted. No refunds are available once the order is submitted. If I decide to cancel the order, I will be entitled only to receive a refund for government filing fees that have not been paid to the government or it’s agents. Once government fees have been paid, no refund is possible. This policy is enacted in order to prevent fraudulent orders.” Furthermore, I confirm that I have read and agree with the Terms of Service Agreement. I confirm the above order and electronically sign and authorize the charges to be processed on the above credit card, and I authorize Business Development Centre to process the order.

Please press Submit Button only once.

By pressing "Submit Form" button I/We confirm the above order and electronically sign and authorize the charges to be processed on the above credit card.

Place your Order Now

Call us at (416) 226-2921 or Toll Free: 1-877-226-2921


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