Workers Compensation Board of Manitoba - Registration Questionnaire for Businesses

Registration Questionnaire for Businesses


Please complete the following questionnaire to start the registration process if: you recently registered with the Companies Office operate a business within one of the industries newly covered by the WCB or the WCB has sent you a letter requesting information about your business. After receiving your form, the WCB will contact you to let you know more about registering with us or to clarify information that you have provided. If you need assistance completing the questionnaire, please call 204-954-4505 or toll free 1-800-362-3340.

* indicates required field
* Legal Name:
Trade Name(s) - if any:

Business Number:

* Street Address or PO Box:

* City/Town:
* Province/State:
* Postal Code/Zip Code:

* Contact Name:
* Phone Number (e.g., 555-555-5555):
Fax Number (e.g., 555-555-5555):
Cell Phone Number (e.g., 555-555-5555):
* E-mail:
Date you began (or will begin) employing workers:
*Estimated Manitoba payroll for workers - current calendar year:
Actual Manitoba payroll for workers - prior year(s) if applicable

(Note - payroll information should not include the earnings of sole proprietors, partners or directors - coverage for these individuals must be purchased separately.)

* Please give us a short description of all your firm's activities. This will assist the WCB in assigning your firm the correct industry classification and rate of assessment. (Limit 1,000 characters.)