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Registration
- CIPC Registration Services
- CIPC Secretarial Services
Packages
Other Services
FAQ’S
Contact Us
Free Consultation

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Apply For Workmen’s Compensation

Navigating Financial Success Together

Workman’s Compensation Registration

1APPLICANT INFORMATION

2COMPANY INFORMATION

3EMPLOYEES INFORMATION

4UPLOAD DOCUMENTS

5REVIEW UPLOADED DOCUMENTS

6REVIEW COMPLETE APPLICATION

7SUBMIT APPLICATION

URL
This field is for validation purposes and should be left unchanged.
Application ID
Applicant information
Name and surname*
Applicant E-mail address*
Cell number*

Company information
Company/CC Name*
Company/CC Registration Number*
Company/CC Address
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Business Description
PAYE Number (if applicable)
UIF Number (if applicable)
Number of Directors*
Director 1
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 2
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 3
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 4
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 5
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 6
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 7
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 8
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 9
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 10
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 11
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 12
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 13
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 14
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code
Director 15
Name and surname*
E-mail address*
Contact number*
Resident of South Africa
- Yes
- No
SA ID number*
Passport number*
No of shares issued to Director
Physical address*
Address Line 1 Address Line 2 City State Zip Code
Postal Address*
- Same As Physical Address
- Street Address
- PO Box
- Private Bag
Street Address*
Address Line 1 Address Line 2 City State Zip Code
PO Box*
Number Post Office Province Postal Code
Private Bag*
Number Post Office Province Postal Code

Employees Information
Number of employees*
Employee 1
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 2
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 3
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 4
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 5
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 6
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 7
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 8
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 9
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 10
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 11
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 12
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 13
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 14
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 15
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 16
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 17
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 18
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 19
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*
Employee 20
Employee name and surname*
Resident of South Africa?
- Yes
- No
SA ID Number*
Passport Number*
Employee start date*
DD slash MM slash YYYY
Employee salary*
Estimated total earnings of employees for the year*

Do you want to upload documents?*
- Yes
- No
Documents Upload*
Drop files here or

Accepted file types: jpg, gif, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB, Max. files: 5.
Allowed Formats: jpg, gif, pdf, doc, docx, xls, xlsx
Max File Size of Each Document Should be 2MB
Max Number of Files Allowed is 5
Documents Required as Below:
1. Company documents
2. Director/Member certified ID copies

Please Note: If these files are too large to upload, please send it to info@registeryourbusiness.co.za, using your Company/ CC name as the subject.

Do you want to review your uploaded documents?*
- Yes! I want to see my uploaded documents
- No, I don’t want to see my uploaded documents
Click on below link to preview your uploaded documents {Image Format Upload:266}

Do you want to review your application?*
- Yes! I want to review my application
- No, Its Fine
Please Review Your Application As Below
{all_fields}

Submit Application
I confirm all information to be true and correct in all aspects and I agree to the registration terms and conditions.
- Yes
- No
Would You Like COID Registration and Letter of Good Standing?*
COID Registration – R1199.00

COID Registration and Letter of Good Standing – R1599.00
- No
- Yes
Total payable
Total
R0.00
Payment Method*
- EFT
- Credit / Debit Card
Banking Details

Bank:FNB
Account Name:Register Your Business
Account Number:627 1367 7493
Branch Code:250 655

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