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WCIRB Connect® for Agencies and Brokerages Registration

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WCIRB Connect® for Agencies and Brokerages Registration

Licensed agencies and brokerages that need 25 or more user accounts must register for WCIRB Connect® by completing the form below. Registration requests will be processed as soon as possible. Upon submission of this form, a contract will be drafted and sent via DocuSign to the Signatory identified in the registration form below. Upon execution of the contract, the System Administrator identified below will receive information regarding how to establish accounts for users. If you are an individual agent or broker or a licensed agency or brokerage that needs less than 25 user accounts, please use the WCIRB Connect for Individual Agents and Brokers registration form to individually sign up for access. 

Requirements for Registration

To register for WCIRB Connect, the business entity must:
 
  1. Have a valid California Casualty Broker – Agent Business Entity license.
  2. Provide a valid company email address. (Free email addresses such as Y! Mail and Gmail will not be accepted.)
  3. Designate a System Administrator to manage the business entity's users.
  4. Accept the WCIRB Website Access Agreement — Casualty Brokers-Agents, 25 or More Users, which the WCIRB will separately provide upon receipt of the completed registration form.

The fields marked with an asterisk (*) in the form below are required.

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

Business Entity License Information

Enter all seven digits/characters of the business entity'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 the Business Entity's 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?

Signatory

The signatory must be an officer or attorney affiliated with the business entity and must be authorized to legally bind the business entity.

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