Void & Reissue Request Form

I have contacted my bank/financial institution to confirm if there is a record of the check being cashed.*
Please check with your bank before submitting this form.
It has been more than 14 business days since the check was issued to me or 30 business days for a check issued to my provider. *
Please allow for more time before submitting this form.
My request is only to void a check. It does not need to be reissued.*
Please allow for more time before submitting this form.
Please allow for more time before submitting this form.

Employee Information

Name*
Please Select*
How many checks?*
mm/dd/yyyy
$
mm/dd/yyyy
$
mm/dd/yyyy
$
mm/dd/yyyy
$

Direct Deposit Information


Your check cannot be reissued as a Direct Deposit, but if you would like to receive Direct Deposit instead of checks for future claims, please enter your banking information here.

Account Type
Account Holder Full Name

Signature


Voya Benefits Company, LLC is not liable for any bank fees associated with expenditures made prior to your financial institution crediting your account with a deposit. It is your responsibility to ensure that funds are available in your account prior to spending them.

Checks that are no longer valid must be returned to Voya Benefits Company, LLC with this form.

Name*
Progress
Cancel
Confirm