Wsib 1009A Form – Fill Out and Use This PDF

Wsib 1009A Form PDF Details

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Wsib 1009A Form – Fill Out and Use This PDF

The WSIB 1009A form serves as a critical tool for employers in Ontario, Canada, facilitating the accurate reconciliation of insurable earnings and premium calculations for workers' compensation insurance. It ensures that all information, from gross earnings before deductions to the final premium amount due, is reported precisely to the Workplace Safety and Insurance Board (WSIB). All information provided on this document is held in strict confidence, safeguarding the privacy of both the employer and employees.

Ensuring the form is filled out accurately and submitted by the due date is paramount to avoid penalties, ensuring your business stays compliant with provincial regulations. For guidance on completing this form, refer to the enclosed Reconciliation Guide, and remember, you are just a click away from fulfilling this essential business obligation efficiently.

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Wsib 1009A Form PDF Details

Understanding the WSIB 1009A form is crucial for businesses that are navigating the complexities of workplace injury and insurance claims in Ontario. This critical document, meant to be filled out and submitted by employers, plays a pivotal role in the reconciliation of insurable earnings and the calculation of premiums owed to the Workplace Safety and Insurance Board (WSIB). When filled out accurately, it details an employer's total gross earnings before deductions, highlights insurable versus non-insurable earnings, and provides a comprehensive breakdown of premiums owed based on the total insurable earnings for a specific period. Furthermore, it categorizes earnings into direct, common, and insurable segments, allowing businesses to allocate funds appropriately and understand their financial responsibilities towards workplace safety and insurance. The form also includes mandatory fields for certification by an owner or authorized officer, attesting to the accuracy of the information provided. Failure to submit this form on time, or accurately, can lead to financial penalties or even prosecution, emphasizing its importance in maintaining compliance and supporting a safe work environment. Its detailed instructions, coupled with the requirement to report in black ink and the stipulation that only the original form should be submitted, underscore the WSIB's commitment to maintaining precise and verifiable records of workplace-related financial activities.

Question	Answer
Form Name	Wsib 1009A Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	wsib 1009a form, wsib for 1009a, 1009a printable fillable, wsib reconciliation 2019 form

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P.O. Box 4115

Station A

Toronto ON M5W 2V3

All information is strictly confidential.

Original

Reconciliation Form

Due Date

Issue Date

Page

Account No.

Firm No.

Reconciliation Period Covered

Telephone Enquiry Number

(416) 344-1000 1-800-387-00

WSIB Interest Rate

Annual −

For information on how to complete this form refer to the Reconciliation Guide.

PLEASE TYPE OR PRINT IN BLACK INK.

Section A - Calculating Total Insurable Earnings

	Gross Earnings Before Deductions
1	Total Earnings per T4 Summary
2	Other Earnings not on T4 Summary
	Contractors’ Earnings
3	Contractors’ Earnings
	Volunteer Forces (complete enclosed Schedule)
4	Volunteer Forces (complete enclosed Schedule)
	Optional Insurance (see Attachment 1)
5	Optional Insurance (see Attachment 1)

6	Total Gross Earnings Before Deductions

	Deductions From Gross Earnings
7	Non−insurable Gross Earnings
	Executive Officers’ Earnings
8	Executive Officers’ Earnings

9	Excess Earnings


10	Total Deductions

11	Total Insurable Earnings (Box 6 minus box 10)

Section B - Allocation of Total Insurable Earnings by Classification You must complete Section B

NOTE:

Do not write over any preprinted information. Only the original should be completed and returned in the envelope provided.

If your business differs from the classification(s) below, notify your WSIB account representative.

Classification

CU Code

CU Description

(A) Direct Earnings

(B) Common Earnings

(C)

Insurable Earnings = (A) +( B)

1009A (10/10)

Section C - Premium Calculation

Classification

CU Code

CU Description

(C)

Insurable Earnings from Section B

(D) Rate per $100

CU Premium

Total

Insurable

Earnings

(Equals box 11)

Total
Premium		13
Amount

	(If less than $100, enter $100)

Total Premium Amount Reported

(The sum of the premiums previously14 reported for this reconciliation period.)

Does the amount in Box 14 match your records?

• If not the reason may be that our records do not show your most recent reporting period. The amount recorded is the total premiums reported throughout the year, not premiums actually paid.

Section D - Certification:

Reconciled Difference (Box 13 minus box 14)

Credit to Account

If box 15 is negative, enter amount here.

Please enclose payment with this form. Payment cannot be accepted at any financial institution.

Amount Due

If box 15 is positive, enter amount here.

Amount Paid

I hereby certify that I am an owner (or authorized officer) responsible for this account and that, to the best of my knowledge, the information on this form and on any documents attached is true and correct.

NOTE:

If this form is not received by the due date, the WSIB will calculate a premium for the reconciliation period and charge 1% of that amount (to a maximum of $1000) for each month the form is not received.

Employers are required to keep accurate records of all earnings and deductions declared on this form. The WSIB must be able to verify the earnings and deductions declared from the employer's records.

Failure to keep proper records, or submitting an inaccurate form, can result in penalty or prosecution.

1009A2

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Account No.

Company Legal Name

Name (please print)

Date Completed