Registrations - WCB Registration Form

WCB Start Up Form

Please provide all required details for us to register you with WCB Alberta

Business Name
Trade Name
If applicable
Business Type
If you selected "Other" above please explain below:
Name

First NameLast Name
Contact Number
Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing address - if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website:
If applicable
CRA Business Number:
Have you ever been previously registered with WCB Alberta?

YesNo
If yes provide details below:
Have you purchased this business?

YesNo
If yes provide details below:
Do you hire workers and/or subcontractors

YesNo
If yes, what is the total estimated gross income paid to workers/subcontractors for the remaining of the year?
How many employees have you hired or plan to hire?
Employee Start Date

MonthDayYear
Date
Do you hire for part of the year (Seasonal Work)?

YesNo
Are you an independent owner/operator of heavy equipment or trucks?

YesNo
Do you own and/or lease any other equipment or assets (over $500 in value)?

YesNo

If yes please list:

Rows	Make	Model	Year	Serial #	Registered owner
Asset 1
Asset 2
Asset 3
Asset 4

Do you perform work outside of Alberta?

YesNo
If yes please list province below:
Do you supply materials?

YesNo
Is your business a franchise or chain establishment?

YesNo
Do you perform services and provide products exclusively to homeowners?

YesNo
Do you advertise?

YesNo
If yes, where do you advertise?
What bank do you use for the business? blanks Location? blank
What bank do you use for the business? blanks Location? blank
Do you have liability insurance?

YesNo
Are you a GST registrant?

YesNo
Please note that if you are a sole proprietor, there must be more than one yes in the above section
Provide a description of your operations including activities performed, products developed and services provided:
Name the companies, organizations or individuals to which your organization contracts.
if you do not provide work to other organizations, leave this section blank
Provide a list of direct competitors (2 or 3).
Reviewing competitors can assist when classifying a new business
Request for personal coverage for directors/owners
Director/Owner 1

First NameLast Name
Date of Birth

MonthDayYear
Date
Earning Coverage Amount
For Basic Coverage amount please type "basic"
Director/Owner 2

First NameLast Name
Date of Birth

MonthDayYear
Date
Earning Coverage Amount
For Basic Coverage amount please type "Basic"
Please submit the following as WCB may use this information to determining eligibility:

Proof of business expenses IE Permits, Business License, Advertising, Cost of Incorporation Proof of Business Bank Account Liability/Commercial Insurance Proof of purchase/ownership of equipment (Bill of Sale or purchase receipt) Proof of multiple concurrent contracts (invoices for work done to various companies) Proof of purchase for materials (3-4 receipts)
Sole Proprietorship: Some additional information may be required. We can not guarantee eligibility as WCB takes into consideration multiple criteria before you are eligible

Workers (other than family members) are employed on a regular basis Revenue Canada source deductions Advertising methods
Please note that there is a $200 activation fee from WCB

Please contact the office about making this payment
File Upload

Cancelof
Signature
Date

MonthDayYear
Date

Business Name
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing address - if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of birth

MonthDayYear
Date
Business Type
If you selected "Other" above please explain below:
Website:
If applicable
CRA Business Number:
Corporation number
This is found on your certificate of incorporation
Jurisdiction
Is the company publicly traded?

YesNo
Is the company a movie or television production company?

YesNo
Date of incorporation

MonthDayYear
Date
Please list any current or previous WCB accounts
Does the firm currently or intend to employ a worker who is not a shareholder?

YesNo

List all shareholders

Rows	Name	Address	Personal Coverage?	Coverage amount
Shareholder 1
Shareholder 2
Shareholder 3
Shareholder 4

Does the company hire subcontractors?

YesNo
How many?
List your subcontractor's names:
Does the company hire employees?

YesNo
How many?
When is the start date of your workers? (subs and/or employees)

MonthDayYear
Date
Does the company work under subcontract?

YesNo
Two or more contacts?

YesNo
List at the most 3 companies that you work under subcontract for:
Has the company ever been affiliated with another firm that operates in B.C.?

YesNo
Is the company involved in an industry here a vehicle is core to their services? (Trucking, courier, taxi, limo or ride hailing)

YesNo
Please provide a summary of the company's current business operations in BC?

List Primary products and services

Rows	Product/Service Type	Percentage
Product/Service 1
Product/Service 2
Product/Service 3
Product/Service 4

On what basis does the company charge clients for its products and/or services?
Contract, Monthly invoices, weekly invoices etc.
Who are the company's competitors?
Where is the work being done?
Commercial location, clients site, your location etc.
Does the company advertise its products and/or services?

YesNo
Does the company conduct business outside of BC?

YesNo
If yes, indicate the province or state:
Does the company own any major revenue-producing equipment?

YesNo
Does the company supply the major material required to fulfill fixed price contracts?

YesNo
Estimated payroll/contactor payments for the year
Date subcontractors or employees first were paid:

MonthDayYear
Date
Signature
Date

MonthDayYear
Date

Company Name
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

List all shareholders

Rows	Name	Address	Personal Coverage?	Coverage amount
Shareholder 1
Shareholder 2
Shareholder 3
Shareholder 4

CRA Business Number
Does your business operate under a different name than above?

YesNo
If yes, please enter the name below:
Is your company a limited or incorporated business?

YesNo
Has this business been purchased?

YesNo
If yes provide details below:
Do you employ Saskatchewan resident workers or subcontractors?

YesNo
Will you come into Saskatchewan 3 or more times per year?

YesNo
Will you work in Saskatchewan more than 5 consecutive dates?

YesNo
Describe your business operations in detail.
Include the products or services you provide
What tools or equipment do you use?
Please provide the names of two of your competitors. This information can help with clasifying a new business
Has your business been hired by (or contracted) any other business or individual to do work?

YesNo
Two Business or individuals you have worked for: 1. blanks 2. blank
Enter your payroll information

Only include information for work performed in Saskatchewan
Do you hire workers?

YesNo
Does your corporation have directors on payroll?

YesNo
If yes, would you like director coverage?

YesNo
If yes please state the coverage amount
If you would like basic coverage just type in basic
Start date of first worker in Saskatchewan

MonthDayYear
Date
Do you hire subcontractors?

YesNo
If yes start date of subcontractors in Saskatchewan

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
Should be Empty:

WCB Start Up Form

Please note that if you are a sole proprietor, there must be more than one yes in the above section

Request for personal coverage for directors/owners

Please submit the following as WCB may use this information to determining eligibility:

Sole Proprietorship: Some additional information may be required. We can not guarantee eligibility as WCB takes into consideration multiple criteria before you are eligible

Please note that there is a $200 activation fee from WCB

Enter your payroll information