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WCIRB Connect® for Agencies and Brokerages Registration

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WCIRB Connect® for Agencies and Brokerages Registration

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Licensed agencies and brokerages may register for WCIRB Connect® by completing the form below. Registration requests will be processed as soon as possible. Based on the volume of responses, it may take up to 10 business days to complete a registration.  If you are an individual agent or broker, please use the WCIRB Connect for Individual Agents and Brokers registration form.The fields marked with an asterisk (*) in the form below are required. 

Requirements for Registration

To register for WCIRB Connect, you must:
  1. Principal or Officer of Business EntityBe an officer or principal of the Business Entity with the authority to agree to the WCIRB Website Access Agreement — Casualty Brokers–Agents on behalf of your company. If you are not, please ask a principal or officer to complete this registration form. 

  2. Have a valid California Casualty Broker – Agent Business Entity license.

  3. Have a company email address. (Free email address such as Y! Mail and Gmail cannot be accepted.)
  4. Designate a System Administrator to manage your users.
  5. Accept the WCIRB Website Access Agreement — Casualty Brokers-Agents.

     

No spaces or dashes
Only enter digits, no dashes or parentheses, i.e. 5551234555

Business Entity License Information

Enter all seven digits/characters of your company’s California Business Entity license including any leading zeroes with no spaces. Form submissions without a valid Business Entity license number will not be processed. If you don’t know your Business Entity license number or expiration date, you may look it up using the California Department of Insurance website at https://www.insurance.ca.gov/0200-industry/0008-check-license-status/.

System Administrator

Who is your System Administrator?

WCIRB Website Access Agreement — Casualty Brokers-Agents 

Please read the agreement below. By clicking on the checkbox, you confirm that you have read the WCIRB Website Access Agreement — Casualty Brokers-Agents and agree that the Business Entity and its users will abide by all of the terms of the Agreement.