WCB Form Service 1 Service Details2 Company Address3 Contact4 Business5 Operations6 Coverage Step 1 of 6 - Service Details 16% Please read the instructions and then fill in the formThrough this form, information is collected SECURELY. Upon receiving information, our agent will set up your WCB accounts. For assistance, please read the right side guidelines. You will be contacted directly by WCB in 5-10 business days after submitting this form.Enter Your Order Number*Order number starts with the letter B. When you placed order on our website, it was generated. You may find it in your order confirmation email in the subject line.Legal Business Name or Applicant Name*CRA Business Number (leave blank if unknown)Business Type: Select business type*Individual/ProprietorshipPartnershipLimited/IncorporatedOtherHave 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:*Did you purchase this business from a previous owner?*YesNoPrevious business name (if different than current name)Date Purchased:*Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Previous Owner Contact Name(s):*Phone Number:*GuidelinesExisting order numberThis is your initial order number with us. If you have forgotten it, you may check your order confirmation email. Order number is in the subject line of the email.Legal business name or applicant nameA legal business name is typically any individual, proprietorship, partnership, corporation, association, or other organization that has the legal capacity to make a contract or an agreement and the ability to assume an obligation and to discharge a debt. The legal business name should not be confused with a trade name. A trade name is the name used by your business to distinguish your goods and services from those of other businesses.CRA business numberIf you have one, enter the nine digit business number used by the Canada Revenue Agency to track corporate income tax, imports and exports, payroll deductions, and the goods and services tax.Previous registration with WCBIf this business organization ever been registered with WCB, former WCB account number is required Company AddressBilling Address Unit/Suite/Apt: Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Delivery Mode:GDSSRRPO BoxMR(PO BOX, RURAL ROUTE, etc.)PO Box or Route Number:Actual physical location of operations Same as billing address Unit/Suite/Apt: Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code GuidelinesBilling addressYour billing address is the address used by the WCB to direct all invoices and financial communications. ContactApplicant's First Name*Applicant's Last Name*Position*Owner/DirectorLegal RepresentativeExternal AccountantEmployeeEmployee RepresentativeOtherRegular Phone NumberPlease provide your email Enter Email Confirm Email GuidelinesContact personPlease supply the name of at least one person we can contact regarding your application.ApplicantThe WCB requires your first and last names, as well as the position you hold within your company. Business1. Do you hire workers and/or subcontractors?YesNoEstimated number of workers (excluding directors)Start date of first workerMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Estimated total payment to workers (excluding directors)2. Seasonal Work: Do you operate for part of the year?YesNoTypical starting month for seasonal workJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberTypical ending month for seasonal workJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember3. 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)?4. 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)?5. Do you perform work outside of Alberta?YesNoPlease list location(s):6. Whether a personal or business bank account, what is the name of the bank used for business?*7. What is the location of the bank used for business?*GuidelinesHiring workersA "worker" is a person who enters into or works under a contract of service or apprenticeship, written or oral, express or implied, whether by way of manual labour or otherwise, or is considered by the WCB to be a worker. For the purposes of this question, a "contractor" or "subcontractor" is an individual, proprietorship or partnership hired by a principal to perform work or services.Seasonal WorkDoes your organization normally hire workers for only part of the calendar year? A "seasonal" operation is one that typically hires workers for only part of each year, and employs no workers over the other months.Independent owner/operatorOwnership of heavy equipment or trucks can affect your qualification for a WCB employer account. List the make, model and serial number of equipment owned by your organization, and provide the name of the registered owner. 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.*GuidelinesBusiness OperationsThe WCB needs this information to determine your qualification for coverage under the Workers' Compensation Act, and to select the appropriate industry classification for your operations. Provide as much information as possible, including your organization's activities, products and services, customers, and equipment and tools used.CompetitorsA list of organizations with which you are in direct competition can assist the WCB in classifying your operations. If your organization operates without competitors, indicate so in this space. 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?YesNoPersonal coverage holders' detailsFirst nameLast nameDate of Birth (YYYY/MM/DD)Coverage Amount ($) Declaration of Accuracy* Yes, I certify the following By my submission I certify that I have the authority to execute this application, and that the facts set forth are true and correct to the best of my knowledge and belief. I am aware that any person who knowingly provides false or misleading information to the Board may be subject to administrative penalties or be found guilty of an offence under the Alberta Workers' Compensation Act.GuidelinesWho is Personal Coverage for?Directors of a corporation or members of a society, board, authority, commission or foundation, partners in a partnership, or business owners with or without workers.What does personal coverage provide?1. Protection against loss of employment income. 2. Comprehensive medical and rehabilitation services. 3. Risk Management. 4. Better business practices..