Form 1014A "Reconciliation Form" - Ontario, Canada

What Is Form 1014A?

Form 1014A, Reconciliation Form, is a formal statement Canadian employers submit to the Workplace Safety and Insurance Board (WSIB) to report the total amount of earnings received by their employees for the last reporting period after they calculate their premium and separate it by classification units and find out the difference between the premium amount they have already reported with the amount owed. Send this document to the WSIB no later than March 31 of the year that follows the reporting year.

Alternate Name:

  • WSIB Reconciliation Form.

The latest version of the document was issued on September 1, 2013, with all previous editions obsolete. A fillable WSIB Reconciliation Form can be downloaded through the link below.

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How to Fill Out WSIB Reconciliation Form?

Here is how you need to complete Form 1014A:

  1. Start with computing the total earnings that can be insured. State the total earnings from the T4 Statement of Remuneration and other earnings not included in that summary. Indicate how much contractors and volunteer forces have earned. Calculate the total earnings adding the optional insurance if the amount is pre-printed in your document.
  2. Outline all deductions from gross earnings - earnings that cannot be deducted, executive officers' and excess earnings. Find out the total amount of earnings that can be insured by subtracting the deductions from the gross earnings.
  3. Allocate the earnings you have calculated by classification. List all earnings, enter their description, the classification unit number, and the duration of the reporting period. Find out the insurance earnings for each position in the table - add direct earnings (those you can assign to the classification unit) to common earnings (earnings that cannot be directly assigned to a specific category because they do not relate to the specific business activity).
  4. Calculate the total premium amount - multiply the insurable earnings by the premium rate, and then divide the number you get by 100.
  5. Report the total premium amount you have already reported throughout the year. If this number does not reflect your records, indicate the reconciled difference - subtract the reported amount from the computed premium amount.
  6. If the reconciled difference is negative, enter the WSIB account number - the reconciliation credit will be applied to the account balance.
  7. Record the amount of money you owe to the WSIB if the reconciled difference is positive.
  8. Write down the amount you are paying and attach the payment with the form.
  9. Confirm your responsibility for the account in question and the accuracy of the statements you have provided in the form.
  10. Enter the account number assigned by the WSIB and the legal name of your business. Record your name and title, the actual date, contact details, and sign the document.
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Download Form 1014A "Reconciliation Form" - Ontario, Canada

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VISIT WWW.WSIB.ON.CA FOR A DETAILED
P.O. Box 4115
GUIDE TO FILLING OUT THIS FORM
Station A
Toronto ON M5W 2V3
All information is strictly confidential.
Working Copy
Reconciliation Form
(For your records)
Due Date
(dd/mmm/yyyy)
Issue Date
(dd/mmm/yyyy)
Page
Start >
Account No.
Firm No.
Address >
Reconciliation Period Covered
Telephone Enquiry Number
416-344-1000
1-800-387-0750
WSIB Interest Rate
Annual -
%
PLEASE TYPE OR PRINT IN BLACK INK.
Section A - Calculating Total Insurable Earnings
Gross Earnings Before Deductions
1
NOTE:
Total Earnings per T4 Summary
Do not write over any preprinted
2
Other Earnings not on T4 Summary
information. Only the original should
be completed and returned in the
Contractors' Earnings
3
envelope provided.
4
Volunteer Forces (complete enclosed Schedule)
Optional Insurance (see Attachment 1)
5
>
6
Total Gross Earnings Before Deductions
Deductions From Gross Earnings
7
Non-insurable Gross Earnings
8
Executive Officers' Earnings
9
Excess Earnings
>
10
Total Deductions
11
Total Insurable Earnings (Box 6 minus box 10)
>
Section B - Allocation of Total Insurable Earnings by Classification
You must complete Section B
If your business differs from the classification(s) below, notify the Employer Service Centre.
Classification
(B)
(C)
(A)
Direct
Common
Insurable Earnings
Reporting Period
Start
End
CU Code
RG
CU Description
Earnings
Earnings
= (A) +( B)
next page
1014A (09/13) WEB
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VISIT WWW.WSIB.ON.CA FOR A DETAILED
P.O. Box 4115
GUIDE TO FILLING OUT THIS FORM
Station A
Toronto ON M5W 2V3
All information is strictly confidential.
Working Copy
Reconciliation Form
(For your records)
Due Date
(dd/mmm/yyyy)
Issue Date
(dd/mmm/yyyy)
Page
Start >
Account No.
Firm No.
Address >
Reconciliation Period Covered
Telephone Enquiry Number
416-344-1000
1-800-387-0750
WSIB Interest Rate
Annual -
%
PLEASE TYPE OR PRINT IN BLACK INK.
Section A - Calculating Total Insurable Earnings
Gross Earnings Before Deductions
1
NOTE:
Total Earnings per T4 Summary
Do not write over any preprinted
2
Other Earnings not on T4 Summary
information. Only the original should
be completed and returned in the
Contractors' Earnings
3
envelope provided.
4
Volunteer Forces (complete enclosed Schedule)
Optional Insurance (see Attachment 1)
5
>
6
Total Gross Earnings Before Deductions
Deductions From Gross Earnings
7
Non-insurable Gross Earnings
8
Executive Officers' Earnings
9
Excess Earnings
>
10
Total Deductions
11
Total Insurable Earnings (Box 6 minus box 10)
>
Section B - Allocation of Total Insurable Earnings by Classification
You must complete Section B
If your business differs from the classification(s) below, notify the Employer Service Centre.
Classification
(B)
(C)
(A)
Direct
Common
Insurable Earnings
Reporting Period
Start
End
CU Code
RG
CU Description
Earnings
Earnings
= (A) +( B)
next page
1014A (09/13) WEB
Section C - Premium Calculation
Classification
(C)
(D)
CU Premium
Reporting Period
Insurable Earnings
Rate per $100
(C) X (D) ÷ 100
Start
End
CU Code
RG
CU Description
from Section B
Start >
Total
Total
Premium
Insurable
13
12
Earnings
Amount
(Equals box 11)
(If less than $100, enter $100)
Total Premium Amount Reported
14
(The sum of the premiums previously
reported for this reconciliation period.)
Does the amount in Box 14 match your records?
• If not the reason may be that our records do not show your most recent reporting period.
The amount recorded is the total premiums reported throughout the year, not premiums
actually paid.
Reconciled Difference
15
(Box 13 minus box 14)
Credit to Account
Amount Due
17
16
If box 15 is negative,
If box 15 is positive,
enter amount here.
enter amount here.
Amount Paid
Please enclose payment with this form.
18
Payment cannot be accepted at any
financial institution.
Section D - Certification:
I hereby certify that I am an owner (or authorized officer) responsible for this account and that, to the best of my knowledge, the information on this
form and on any documents attached is true and correct.
Account No.
Company Legal Name
Date Completed
Name (please print)
Title
(dd/mmm/yyyy)
Area Code
Signature
Area Code
Telephone No.
FAX No.
Please print form & sign before returning to the WSIB
(
)
(
)
NOTE:
If this form is not received by the due date, the WSIB will calculate a premium for the reconciliation period and charge 1% of that amount (to a
maximum of $1000) for each month the form is not received.
Employers are required to keep accurate records of all earnings and deductions declared on this form. The WSIB must be able to verify the earnings
and deductions declared from the employer's records.
Failure to keep proper records, or submitting an inaccurate form, can result in penalty or prosecution.
1014A2 WEB
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