Corporation Registration

This information is being collected for the purposes of administering and enforcing the Workers’ Safety and Compensation Act and is collected under the authority of that Act and the Access to Information and Protection of Privacy Act. If you have any questions about the collection of this information, please contact the Privacy Officer at WSCB at the above listed address or at (867)667-5645 or 1-800-661-0443.

You will need the following information to complete this form:

a) legal name of your business
b) CRA business number if you have one;
c) description of business activities and primary business purpose;
d) full names of directors, birth date and address;
e) payroll information, estimate of annual payroll;
f) information about contractors or subcontractors.

Employer Information

Legal Name

Trade Name

CRA BIN Number

Street Number

Street Name

City

Province/Territory

Postal Code

Country

Primary Phone Number

Secondary Phone Number

Fax Number

Is the physical address the same as mailing address?

Yes No

Only needed if mailing address is different from address you provided above

Have you had an account with Workers' Safety and Compensation Board in the Yukon before?

Yes No

What date will your workers start to work in Yukon?

Director Contact Information

How many directors does the business have?

Maximum five entries

Business Contact Information

Have you identified a payroll, claims, workplace safety contact?

Yes No

Employer Business Information

Is the Yukon your home jurisdiction? (Your home jurisdiction is where your head office is.)

Yes No

How many workers including casuals do you have on average? Please include directors. Directors of corporations are workers under the WSCB.

1-10 11-25 26-50 51 or more

Please describe your business activities and primary business purpose.

What type of tools are used?

What types of products, goods or services does your business provide?

Do you have more than one business purpose?

Yes No

Please provide the location of your workplace in the Yukon.

“Workplace” means a building, site, project site, workshop, structure, vehicle or mobile equipment, or any other location where one or more workers perform or have performed work.

Has your business been contracted by any other business to do work in the Yukon?

Yes No

Does your business hire any contractors or subcontractors?

Yes No

Payroll Information

For your workers, including directors, that are working in the Yukon, what is your estimated assessable payroll to December 31?

Please note: dividends are not assessable payroll. Your total estimate is the amount of payroll for each worker for the time they are working in the Yukon (do not exceed the maximum annual earnings per worker of $94320 for 2023 and $102017 for 2024. Please only enter the numeric value, no added symbols, i.e. 91500)

Is there any additional information you would like to provide to assist us with the registration of your business?

Signature, consent and declaration

By checking this box, I acknowledge that electronic communication has inherent security risks, as do all forms of communication. Notwithstanding the inherent risks of electronic communication, I consent to the use of electronic methods to transmit and receive information, including confidential and personal information between the board and myself. This consent will remain in effect until written notice to revoke this authorization has been received by the board.

By checking this box I declare that the information provided is true and correct.

My name is

My email is

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