Clearly print your account number on the front of your cheque.
Please return your completed form, along with any applicable payment, using the self-addressed envelope to:
P O Box 4115, Station A,
Toronto ON, M5W 2V3
The WSIB must receive your completed reconciliation form and payment by the due date indicated. You may make an online payment or send a post-dated cheque to ensure that payment is received by March 31, 2021. If the reconciliation form itself is not received by the due date you will be subject to a non-compliance charge. See details on late reporting and payment penalties.
If you have Schedule 1 coverage by application and you do not meet your payment and/or reporting obligations, the WSIB may cancel your coverage.
Use the return envelope only for:
- The original, completed reconciliation form
- Your payment
- The optional insurance request/change form, if applicable, or
- The schedule for volunteer forces, if applicable.