FORM: Change of name or contact information | Workers' Compensation Appeal Tribunal (WCAT)

Let WCAT know right away if your name, address or contact information has changed. If not, your appeal or application may be dismissed, or, if you’re participating in an appeal or application, the appeal or application will proceed without your participation. You also need to let WorkSafeBC know of any changes.

Questions marked (Required) must be filled in so that WCAT can make the changes.

Collection and use of personal information: Personal information on this form is collected for the processing and adjudication of a WCAT matter under the Workers Compensation Act and the Freedom of Information and Protection of Privacy Act. Contact the Freedom of Information Coordinator at WCAT if you have questions.

What appeal or application are you participating in?

List below the appeal number for at least one active WCAT appeal or application you have started or are participating in.

WCAT appeal number (e.g. A2109999) (Required)

Your name (Required)

Please give your current name. If you are changing your name, you will have a chance to give us your old name later.

First Last

What is your role in the WCAT appeal(s)/application(s) listed above? (Required)

I am the worker
I am the employer
I am the dependant of a deceased worker
I am a representative
I am a service provider or a witness
I am an interested party

What contact information would you like to update?

I am updating (check all that apply): (Required)

Give us your update

My previous name (Required)

First Last

My new name (Required)

First Last

My job title and company or organization (if applicable)

You must provide documentation for your name change. You can send us a copy by mail, email, or fax. We can accept any of the following:

a change of name certificate
a marriage certificate
a birth certificate
a citizenship card
any other official government document(s) that show(s) your old name and your new name

My pronouns (Required)

They/Them
She/Her
He/Him
Pronouns not listed

My pronouns (Required)

Please tell us your pronouns.

My title (Required)

Please tell us how you would like to be addressed.

Old mailing address (Required)

Street address Address line 2 City Province / State / Region Postal / Zip code Country

New mailing address (Required)

Street address Address line 2 City Province / State / Region Postal / Zip code Country

This is my new email address: (Required)

Enter email Confirm email

WCAT only corresponds by email for appeals that are not visible on WCAT Online Services or for participants with roles not supported by WCAT Online Services

If you are using WCAT Online Services, you must log on to WCAT Online Services to see your documents, and to change your email address.

This is my new phone number(s) (Required)

Click/tap the plus sign if you want to give us multiple new numbers.

Type (daytime, other, fax number)	New number

Old business/firm name and/or mailing address (Required)

Business/Firm name Street address City Province / State / Region Postal / Zip code Country

New business/firm name and/or mailing address (Required)

Business/Firm name Street address City Province / State / Region Postal / Zip code Country

I am updating another type of contact information

Please tell us about the type of information you want to update, and give us both the old and new information.

Certification

Full name of the person signing this form (Required)

I understand that checking this box constitutes a legal signature confirming that: (Required)

I confirm the information on this form is correct and complete.

Date signed

Email address for form confirmation

Enter an email address here if you would like to receive confirmation that WCAT received your form. WCAT will send you a copy of the completed form by mail or email (depending on your preferences as shown on the notice of appeal or participation form).

Enter email Confirm email

Comments

This field is for validation purposes and should be left unchanged.