aeatant after fait atoren, 1952 Employees Provident Fund Scheme, 1952 we - 19 (are) Form — 19 (UAN) (or west ary et or 11 ran) a stent ar aT Peo, ane Hear wen fs OTA sem LT, aha ae Samet Baer er, aT E I) (Applicable in eases where employee's complete details in Form 11 (New), Azdhaar Number and Bank Accounts details are available on UAN Portal and UAN has been activated) aoe Sag Mae ia a 1] caetor erat leer (2.0.06) / Universal Account Number T ] WAN 2 aa (ease aie A / Name (in capital ees) 3. | atest whee # FARE Date of Leaving sevice att og a aT |e) tafe / Cessation, (Cratos, ster Fe Fa ew oe eT Fer Se) ag) rte Rx / Supamvation Reason of Leaving sevice [OD FAP / Resignation (ick the apeopit for TDS purposes) (oar 1 Disablement | (©) Ber aR / Termination |e wae eres / ita, a abe carer A a / ae Contraction / Discontinuation of employer's business ar aatandh Revo Bak aeUT cases beyond the contol of employee ees eT / Personal reasons (%) Prats! Mariage (6) fer A ee Fae / Permanent settlement abvoad S| gaat rat afear (8) J Permanent Account Number (PAN) sear et Son ISee ra Far 8, aA LE cy Whathor eubmiting Form 15G/18H, # applicable (YESINO) Bee wt Ison ISee A at RAAT a, aE APL EY Prease enclosed two copies of Form No. 15GII5H, i applicable sivas 5 a & a Bar & same A Only in case of fonice loss than § yoars & | aq eee war) Full Postal address ___| fer te in coe +a anti acer & fi at oa, ote oe ate fase me weer at orc ware er fe & ae GEE ai 11 (aan, ae rar eer ser ner ae Bier wa rer we TET | | certify that I have gone through the data seeded in UAN Portal and found all data, including Form No. 11 (New), bank account details and Aadhar number, to be correct. sprees, oes we othe me de and A ogra wt | eee Oe (eer A am, de Gren ger eT aigen.re, te afta) gee ar det | Please make payment in the bank account mentioned in the UAN portal. A cancelled cheat bank account number and IFS Code) is attached herewith, e (containing member’s name, wrap / Signature of the Member