Wsib Premium Remittance Form PDF Details

The WSIB Premium Remittance Form is a document that collects all the necessary information to determine an employer's premiums for workers' compensation coverage. This form must be completed and submitted to the WSIB every year, and it covers all of the employees who are covered under the organization's policy. The premiums assessed will depend on a variety of factors, such as the number of claims filed by your workers and your company's accident rate. Make sure you're familiar with all of the requirements for completing and submitting this form so you can ensure accurate and timely payments.

Form NameWsib Premium Remittance Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other nameswsib premium remittance form pdf, wsib forms upload, premium remittance wsib form, wsib premium remittance form

Form Preview Example

Completing Your


General Information

The top part of the Premium Remittance Form is a work sheet to calculate your insurance premium payment. Keep it for your records, and for audit purposes.

Complete and return the bottom part, (the stub) with your payment.

Premiums not reported by the due date will result in a non-compliance charge.

Need help? See the next page for contact information.


If your irm has one CU

1.Write the total insurable earnings amount for all workers, including optional insurance, in Column A beside the CU description.

2.Multiply the amount in Column A by the premium rate in Column B.

3.Divide the total by 100 to get the premium amount owing.

4.Write the premium amount in Column C.

5.Write the premium amount in the CU Premium column on the remittance stub beside the CU description.

Make sure you know

How the WSIB deines a worker for the purposes of reporting and paying insurance premiums

If you have special reporting issues, such as

Contractors (including subcontractors)

Workers who earn over this year’s annual maximum insurable earnings of $79,600

Optional insurance for sole owners, partners, independent operators and executive oficers

More than one Classiication Unit (CU) preprinted on your form

Volunteer forces

See Details on next page.

Your form has preprinted information speciic to your account. If you ind a discrepancy, please contact your account representative. Processing delays or errors occur if you

alter the preprinted information

return a photocopy or,

use a form from a different reporting period.

Calculating your payment

1.Determine the workers you are reporting earnings for during this reporting period. See Details on next page.

2.Determine the gross earnings for each worker during the reporting period. This includes optional insurance and volunteer forces, if applicable. Gross earnings include items such as room and board, vacation pay, and amounts shown as deductions on T4s for income tax, beneit plans, etc.

3.Deduct non-insurable gross earnings such as supplementary maternity beneits, executive oficers earnings, and excess earnings from the total gross earnings. (Details on next page.) This gives the total insurable earnings. For more details about insurable earnings, contact your account representative.

4.Include the labour portion of the contract for contractors (subcontractors) that you and the WSIB consider to be workers.

If your irm has more than one CU

The earnings related to work performed are considered either direct or common.

Direct earnings are earnings that can be assigned to a CU directly from records that clearly show the earnings by business activity.

Common earnings are for work completed to support business activities in two or more CUs and can include human resources, accounting, administrative staff, and people covered by optional insurance. If Common work is performed, you must include a portion of the Common earnings with each CU when calculating premiums as follows:

1.Determine the direct earnings for each CU.

2.Total the direct earnings from all CUs.

3.Determine the total common earnings.

4.Divide the direct earnings for each CU by the total direct earnings for ALL CUs. This results in the proportion of common earnings to use for each CU. Then multiply each amount by 100 to get the percentage.

5.Multiply the percentage for each CU by the total common earnings. This gives the amount of common earnings to assign to each

CU description.

6.Add the common earnings amount PLUS direct earnings for each CU. Write the totals in Column A beside the appropriate CU.

7.Multiply the igures in Column A by the premium rates in Column B.

8.Divide the totals by 100 to get the premium owing for each CU, and write the amounts in Column C.

9.Add the amounts in Column C. This is the premium amount due for this reporting period.

10.Write the premium amount for each CU from Column C in the CU Premium column on the remittance stub.

No earnings to report?

Write ‘0’ (zero) as the insurable earnings for any CU that has zero earnings for this reporting period.

Completing Your


Making your payment

You can pay by ePayment, at most inancial institutions, by debit card at your local WSIB ofice, or by cheque.

Make the cheque payable to the WSIB.

Clearly print your account number on your cheque. You may post-date the cheque to the due date.

Send your cheque and stub to PO Box 4115, Station A, Toronto ON M5W 2V3 or to one of our ofices.

For ePayments, mail your Premium Remittance stub so the WSIB receives it before the due date.



A worker is anyone you employ in your business under a contract of service or apprenticeship. Any member of the family (including a spouse, children or relative of a sole owner, partner

or executive oficer) who is employed under a contract of service and receives earnings is considered a worker.

Workers can be employed either full-time, or part-time, including seasonal or temporary employees, students, apprentices and learners, and training participants.

Contractors (including subcontractors)

A contractor (subcontractor) is an individual or company that you enter into an agreement with to perform a service on your behalf.

If the contractor does not employ other workers, he or she may be considered either a worker or an independent operator

If you consider an individual to be an independent operator, you must have the WSIB conirm their status and keep copies of letters of conirmation.

If the WSIB determines the contractor is a worker, then you must include the labour portion of the contract as gross insurable earnings when you calculate your premium payment.

Earnings over the maximum (excess earnings)

The WSIB sets an annual maximum for insurable earnings.

For 2011 the annual maximum is $79,600

For workers who earn over the maximum, include only up to the maximum when calculating the premium.

Optional insurance

Include optional insurance amounts for this reporting period in the gross insurable earnings calculation.

Sole owners, partners, independent operators and executive oficers are not automatically entitled to WSIB beneits, but may apply for optional insurance coverage.

People with optional insurance are considered workers for reporting and premium purposes. If injured, they are eligible for the same beneits as other workers.

To cancel optional insurance, contact your account representative.

If you need help and do not know your account representative’s name and phone number,

contact the WSIB ofice nearest you.

0976A (12/10)


(519) 826-4650




(905) 523-1800




(613) 544-9682




(519) 576-4130




(519) 663-2331



North Bay

(705) 472-5200




(613) 237-8840



Sault Ste. Marie

(705) 942-3002



St. Catharines

(905) 687-8622




(705) 675-9301



Thunder Bay

(807) 343-1710




(705) 235-6130




(416) 344-1000

(Ontario only)



(519) 966-0660



Canada wide


If your business is in:

Agriculture, call Guelph

Forestry, Pulp & Paper, call Thunder Bay

Mining, call Sudbury