If you do not receive a letter confirming receipt of your appeal within seven business days, please call Board Services at 306.787.8753 or 1.800.667.7590. Thank you.

You are about to submit an appeal because you disagree with a decision that has been made by the Appeals Department or the Assessment Committee.

Click here to read about WCB's appeal process.

Date of Appeal: su syys 22, 2019 18:42:05 CST Worker Information WCB claim number: example:12345678 Worker first name: Worker last name: Address: City: Province: AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory   Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Postal Code: Country: CanadaUSA   Canada USA Phone Number: Email Address: example: example@domain.com

Employer Information Firm number: First name: Last name: Contact: Phone Number: Email Address: example: example@domain.com

Do you wish to meet to explain your appeal?	Yes No
Are you the appellant?	Yes No