vwovherh afte fer atarer, 1952 Employees Provident Fund Scheme, 1952 wrt - 10 ft que) Form ~ 10C (UAN) (4 aia & any set wt 11 Gen) Hastert at gr Rawr, see dear ae de war weer Zea. dies wy Saaet & ar ace, at |) ‘Applicable in cases where employee's complete details in Form 11 (New), Aadhaar Number and Bank Accounts details are available on UAN Portal and UAN has been activated) (rarer fare rer dy order fh fewfe a srt (fo be filed only if Withdrawal Benefit is applied for) args Hear | Mobile Number 1] afar ara ear (8.6) 7 Universal Assount Number ua ‘aT (FS HA A) / Namo (ln capital les) ee A ane FART Date of oining | seh Ged RT| Dae of aavingsenice T 5. | qq war! Full Postal Address ‘ea aS / Pin code sf omits mr ¢ Pra ques, sts oe ahs feo me ster at at eee fe fer fae et 11 (eam, es wre Reon ser ane area afer wa rer EY sre | {certify that I have gone through the data seeded in UAN Portal and found all data, including Form No. 11 (New), bank sccount details and Aadhar number, to be correct saprar queer, shes oe eet me des are A ener wt | Arce Ow (Ree a, dex re sear aT angem.re, ts afta) sae ae dest f Please make payment in the bank aecount mentioned in the UAN portal A cancelled cheque (containing member's name, ‘bank account number and IFS Code) is attached herewith, wee & eee | Signature of the Member