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01. Edit your wsib provider payment request form online
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02. Sign it in a few clicks
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Send wsib 3947a printable via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out wsib payment form with our platform
- Click ‘Get Form’ to open the wsib payment form in the editor.
- Begin by filling out the Worker Information section. Enter the Claim Number, Worker’s Surname, Given Name(s), and Date of Birth using black ink for clarity.
- In the Provider Information section, input your Provider/Facility Name and Full Address. Ensure you include your WSIB Provider ID and HST Registration No. if applicable.
- For Service/Treatment Information, list each service separately. Fill in the Service Code, Description of Service/Treatment, Fee per Service, and Amount Billed for each entry.
- Finally, certify that all information is accurate by signing and dating the form before submission.
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We've got more versions of the wsib payment form form. Select the right wsib payment form version from the list and start editing it straight away!
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2016 | 4.8 Satisfied (126 Votes) |
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