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
- Have a valid California Casualty Broker – Agent Business Entity license.
- Provide a valid company email address. (Free email addresses such as Y! Mail and Gmail will not be accepted.)
- Designate a System Administrator to manage the business entity's users.
- 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.