Submitted online at Member e-seva portal on 2025-02-06 21:39:15 (IP www.epfindia.gov.
in
Address:152.58.75.214)
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 Member Portal and UAN has been activated.)
Mobile Number / eksckby uacj - 6266415700
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101843205136
3. Name of the member DEVENDRA SINGH
4. Date of Joining 17-May-2023
5. Date of Leaving Service/ NksM+us dk fnukad 31-May-2023
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k CESSATION (SHORT SERVICE) - Any other
reason
7. Permanent Account number / LFkk;h [kkrk la[;k LZSPS4552F
8. Payee Address S/0 Mahesh chand bahadurpura
Bari,Dholpur,DHAULPUR,RAJASTHAN-
328021
* 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 Member Portal and found all data including Form
No.11 (New) , bank account details and Aadhar Number to be correct
Father/Husband/Spouse Name: MAHESH CHAND Date Of Birth: 04-Dec-2001
Bank Account Number 40149287134 Bank IFSC Code SBIN0031065
Bank Details STATE BANK OF INDIA,BARI
Aadhaar 72XXXXXXXX23
Member ID MRNOI19561850000014732
* —i;k ;w-,-,u-iksVZy ij n'kkZ, x, cSad [kkrs esa Hkqxrku djsaA
* Please make payment in the bank account mentioned in the Member portal .
* The bank kyc has been online verified by bank and has been digitally signed by the employer for this case among
other validations and therefore mandatory uploading of the image of cheque leaf/attested bank passbook is not
required.
