Workers Compensation Board of Manitoba - Questionnaire for New Businesses

Questionnaire for New Businesses


Please complete the following questionnaire if: you recently registered with the Companies Office operate a business within one of the industries covered by the WCB or the WCB has sent you a letter requesting information about your business. The WCB will review the information you provide and if it is determined that you are required to purchase WCB coverage, we will contact you. If you need assistance completing the questionnaire, please call 204-954-4505 or toll free 1-800-362-3340, extension 4505.

* 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 description of all your firm's business activities. (Limit 1,000 characters.)