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Submitted online at UAN e-seva portal on 2022-04-26 12:53:33 (IP www.epfindia.gov.

in
Address:49.204.193.252)

deZpkjh Hkfo"; fuf/k ;kstuk] 1952


EMPLOYEES' PROVIDENT FUND SCHEME,1952
EMPLOYEES' Pension Scheme,1995
UAN Based Combined Claim Form 19/10C WB/31 for Advances/PF Final Settlement/Pension Fund Withdrawal
(mu ekeyksa esa ykxw tgka QkeZ 11(u;k)esa deZpkjh dk iwjk fooj.k] vk/kkj la[;k vkSj cSad [kkrk la[;k ;w-,-,u- iksVZy vkSj ij
miyC/k gS rFkk ;w-,-,u- esa lfØ; gSA)
(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.)
Mobile Number / eksckby uacj - 6309142564
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100262082738
3. Name of the member PUNURU MASTANAIAH

4. Date of Joining 13-Oct-2006


5. Date of Leaving Service/ NksM+us dk fnukad 25-Jan-2022
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k RETIREMENT

7. Permanent Account number / LFkk;h [kkrk la[;k N.A.

8. Payee Address kuricherlapadu venkatachalam,Nellore,----


,ANDHRA PRADESH-524405

* eSa çekf.kr djrk gw¡ fd eSaus ;w , ,u iksVZy ij lhM MkVk dks Hkyh Hkk¡fr ns[k fy;k gS rFkk QkeZ u- 11( u;k ) cSad [kkrk fooj.k vkSj vk/kkj
la[;k lfgr lHkh MkVk lgh ik;k x;k gSA
* I 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
Father/Husband/Spouse Name: PENCHALAIAH Date Of Birth: 01-Jan-1962
Bank Account Number 62439870690 Bank IFSC Code SBIN0013391
Bank Details STATE BANK OF INDIA,VENKATACHALAM
Aadhaar 56XXXXXXXX46
Member ID APHYD00260490000004477
* —i;k ;w-,-,u-iksVZy ij n'kkZ, x, cSad [kkrs esa Hkqxrku djsaA
* Please make payment in the bank account mentioned in the UAN portal .
UAN - 100262082738 Tracking ID - 10026208273801001

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