Registration Form

Small Employer Certificate of Recognition (SECOR)

1. Program Information:


2. Company Information:

Legal Name (*)
Operating Name (*)
SK WCB Account # [Ex. 7382910 or A394829] (*)
SK WCB Rate Code(s) [Ex. B1101] (*)
City (*)
Postal Code (*)
Address (*)
Phone (*)
Fax
Email (*)
Owner (*)
Do you have any related companies? (*)


If yes, please list below (* = required).
Legal Name (*)
SK WCB Account # [Ex. 7382910 or A394829] (*)
SK WCB Rate Code(s) [Ex. B1101] (*)
Legal Name
SK WCB Account # [Ex. 7382910 or A394829]
SK WCB Rate Code(s) [Ex. B1101]
Do you, or will your company act in the role of a general contractor, or management company employing more than 9 workers on a regular basis? (*)


If yes, please provide an explanation where you may employ more than nine workers (required).