Registration Form

Certificate of Recognition (COR)

1. Head Office Information:

Company Name (*)
Address (*)
City (*)
Postal Code (*)
Phone (*)
Fax
Senior Manager
E-mail (*)

2. Saskatchewan Office:

Company Name (*)
Address (*)
City (*)
Postal Code (*)
Phone (*)
Fax
Main COR Contact (*)
E-mail (*)
SK WCB Account Number (Ex. 7382910 or A394829) (*)
SK WCB Rate Code(s) (Ex. B1101) (*)
Each WCB Account Number must apply for a separate COR.
Why is the company registering for COR? (*)

3. Please check which to apply for:



Certificate of Recognition (COR®) Registration Compliance Declaration (*)