ValassisBenefits.com

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	About Your Benefits
		Overview
		Medical
		Dental
		Vision
		Disability
		Life Insurance
		Flexible Spending Accounts
		Retirement Savings Plan
		Employee Stock Purchase Plan
		Time Off & Leaves
		Voluntary Benefits & Discounts
		Other Benefits
		Administrative Information
		Glossary of Health Insurance Terms
	What if I...?
	Find out what you need to do if you:
		Join Valassis
		Get Married
		Want to Add a Domestic Partner
		Start a Family
		Leave Valassis
		Experience Other Changes...

FORMS & DOCUMENTS

Download Benefits-Related Forms and Documents

Below is a list of forms and documents associated with your benefits. These forms are in PDF - Adobe Acrobat format. When you select a link to a form, the form will open (with Adobe Acrobat software) in a new window. If you do not have Adobe Acrobat software installed on your system, you may download the software from the Adobe site.

Form Type	Form Name
Retirement Savings Plan	Beneficiary Form Rollover Instructions Rollover Application Rollover Certification Fund Performance
Employee Stock Purchase Plan	Payroll Deduction Authorization Form Bonus Deduction Authorization Form Stock Purchase Plan Sale Request Form Stock Purchase Plan Transfer Request Form Stock Purchase Plan Price Summary
Vacation Plan Forms	Purchased Vaction Request Form
Adoption Forms	Adoption Reimbursement Plan Application Adoption Time Off Request Form (Valassis Communications Inc. and NCH associates paid through the ADP system)
Benefits Handbook	Coming Soon
Credit Union	Membership Application
Domestic Partners	Domestic Partnership Declaration Termination of Domestic Partnership
Educational Assistance	Education Assistance Application Education Assistance Reimbursement Form Education Assistance Degree Form
WageWorks	FSA Health Care Reimbursement Form FSA Dependent Care Reimbursement Form CitiBank HSA Check Contribution Form
Life Insurance	Sun Life Life Insurance Claim Packet Sun Life Evidence of Insurability Form Sun Life Beneficiary Designation Form - English Sun Life Beneficiary Designation Form - Spanish
Long Term Care Insurance	UNUM Long Term Care Conversion Application (Valassis Direct Mail and Sales and Marketing associates paid through the PeopleSoft system)
Medical/Dental	Cigna Dental Claim Form Medical Claim Form Home Delivery Prescription Drug Form Understanding Your BCBS Explanation of Benefits (EOB) Statement
Other Forms	2010 Form W-4 2010 Form W-4 (Spanish version) Employment Eligibility Verification Form: I-9

Important Legal Information: This site is designed to provide easy-to-understand explanations of the key features of the Valassis benefit plans. These descriptions do not necessarily include all the plan details, which are contained in the official plan documents. In the event of any contradiction between the information in these Summary Plan Descriptions and the official plan documents, the official plan documents will govern in all cases. More information...