The Workers Comp Affidavit is a crucial document in Canadian business operations, particularly in contexts where proof of workers' compensation compliance is required. This affidavit is commonly requested during bidding processes, contract negotiations, or when engaging with new business partners. It serves as a sworn statement that verifies an organization's adherence to provincial workers' compensation regulations, including current coverage status, premium payment history, and claims record. The document is especially important in high-risk industries or large projects where multiple contractors are involved. The affidavit helps protect all parties by ensuring proper coverage is in place and reducing potential liability risks. It must comply with provincial workers' compensation legislation and requirements for sworn statements under Canadian law.
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1. Identification of Deponent: Full legal name, position, and business address of the person making the affidavit
2. Business Information: Legal business name, registration details, and principal business address
3. Workers Compensation Coverage Declaration: Statement confirming active workers' compensation coverage, including policy numbers and coverage dates
4. Employee Information: Declaration of number of employees and confirmation that all eligible workers are covered
5. Compliance Statement: Declaration of compliance with all workers' compensation laws and regulations
6. Premium Payment Status: Statement confirming that all premiums and assessments are current and paid in full
7. Claims History Declaration: Statement regarding any recent claims or pending matters
8. Attestation: Formal statement affirming the truth of all declarations made in the affidavit
9. Jurat: Formal closing including date, location, and notary/commissioner details
1. Subcontractor Declaration: Required when the business uses subcontractors, confirming their workers' compensation coverage
2. Multi-jurisdiction Operations: Required when the business operates in multiple provinces/territories
3. Independent Contractor Status: Required when the deponent needs to confirm their status as an independent contractor
4. Exemption Declaration: Required when claiming any legal exemptions from workers' compensation coverage
5. Project-Specific Information: Required when the affidavit is being prepared for a specific project or contract
1. Schedule A - Certificate of Insurance: Current workers' compensation insurance certificate
2. Schedule B - Premium Payment History: Documentation of premium payments for the past 12 months
3. Schedule C - Claims History Report: Official report of workers' compensation claims history
4. Schedule D - Subcontractor List: List of all subcontractors and their workers' compensation policy information
5. Schedule E - Corporate Organization Chart: Organization chart showing employee structure and coverage requirements
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