Application for registration 2021

To ensure we can process the application quickly, please complete this form as thoroughly as possible.

Part A - General information

Input your Canada Revenue Agency business number.
What is the registered legal name of the company acting as an employer? This field is required.
If you use a name other than your legal name to conduct business, answer 'No'.
Provide the following details about your business address.
This field is required.
This field is required.
This field is required.
Please provide us with up to 3 phone or fax numbers for your business.
Include area code and use the following format: 123-456-7890. This field is required.
Please identify the type of phone that this number is. This field is required.
Include area code and use the following format: 123-456-7890.
Include area code and use the following format: 123-456-7890.
By providing your email address, your permit YWCHSB to correspond with you by email.
Name the individual or business that manages your payroll. This field is required.
Include area code and use the following format: 123-456-7890. This field is required.
Name the individual at your business who manages claims. This field is required.
Include area code and use the following format: 123-456-7890. This field is required.
Was there a previous owner of the business? If so, identify the business or individual here.
What does your business do? How does it deliver products and services? This field is required.
Identify the locations at which you conduct business in the Yukon. This field is required.

Part B - Assessable payroll

When did you first hire a worker in the Yukon? This may not be the same as the date you started your business. This field is required.
This field is required.
To get your estimate:
-You must include earning of directors of incorporated companies.
-Cannot exceed $91,930 per worker.
-Must be for the entire calendar year.
-Do not include wages for sole proprietor or partners of non-incorporated companies. Coverage for these is optional.
This field is required.

Part C - Limited companies

Part D - Optional coverage

This does not apply to limited companies or Directors of Limited Companies.
If you are self-employed, i.e. as a proprietor or partner, you may apply for compensation coverage for yourself (and/or your partners if you are authorized to do so). Wage loss benefits will be based on the coverage you have purchased to a maximum of 75% of actual proven earnings.
If you are a non-profit society incorporated under the Societies Act, and the Directors perform volunteer work for the society, the Directors may be eligible for coverage. Contact the Board for more information.

Part F - Submission verification

In place of a signature, please verify your identity. This field is required.
We’ll send an acknowledgement of this submission to your email address. By providing your email address, your permit YWCHSB to correspond with you by email. This field is required.
For any follow-up, we'll need your phone number. This field is required.
Please note that your coverage does not begin until your application has been approved by YWCHSB and you have been contacted by someone at YWCHSB regarding your coverage. For more information please contact (867) 667-5645 or 1-800-661-0443.
This tool helps us reduce unauthorized submissions being made through this form.