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Surplus rebate credit request

Eligible businesses will receive their surplus credit by cheque within 45 days of submitting the request form. We will contact you if we are unable to process your request for any reason.

Please don't complete the rebate cheque request form unless a credit has been applied to your account.

Account number *

Legal name/ trade name *

Requester Name *

Requester Position *

I am authorized to make requests for this account. You can complete the authorization for access to business account information form if you are not currently authorized to make requests for this account. *

Download the authorization for access to business account information form

Phone number *

Email address *

Address (Street/Apt. No./P.O. Box/R.R. No.) *

City/Town *

Postal Code *

Province *

Country *

The information provided in this form will be used solely for the purpose of processing your request to receive your surplus rebate credit by cheque. The contact information provided on the form will not be added to your WSIB employer account. For more information please see our privacy policy.

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