CHECK LIST

(Please fill only below given Sr. Number's, duly filled and signed)

Form-19 & 10C (Employee PF & Pension withdrawal)

1. Please ( √ ) check for Final PF Withdrawal or Pension Withdrawal Benefits
2. Name of employee
3. a)UAN No and b) PF a/c Number.
4. Aadhar Number
5. Father's or Husband Name
6. Date of Birth
7. Date of Joining
8. Date of Leaving
9. a) PAN number , b) Reason for Leaving: Personal Reasons
11. Bank Account number and Full Bank Branch address:
Check Bank Account Number with KYC detail (Match / Not Match)
12. Full Current Address of Employee

Important - “Member’s Signature” in Left Bottom of Page and need to sign.

Write your mobile number on top of form to get SMS alerts.

Note: Please attached below given document:

1. a) Attested copy of Bank Passbook or statement or crossed cheque, (on the cheque, statement or passbook,
Employee name should be printed on Cheque with IFSC code, and branch address.) leaf written as
canceled.

b) Bank A/c in joint name is not acceptable.

c) Bank A/c in joint name (with spouse) is acceptable only with marriage proof.

2. UAN card copy

3. Attested copy of AADHAR and PAN CARD.