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The document is a submission of a UAN Based Combined Claim Form for PF Final Settlement by member J Dinesh Babu, with a UAN of 100451580467. It includes personal details such as joining and leaving dates, reason for leaving, and bank account information for payment. The claim has been certified as correct and verified by the bank, eliminating the need for additional documentation.

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foreverdinesh01
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29 views1 page

PDF Download

The document is a submission of a UAN Based Combined Claim Form for PF Final Settlement by member J Dinesh Babu, with a UAN of 100451580467. It includes personal details such as joining and leaving dates, reason for leaving, and bank account information for payment. The claim has been certified as correct and verified by the bank, eliminating the need for additional documentation.

Uploaded by

foreverdinesh01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Submitted online at Member e-seva portal on 2025-04-09 21:22:10 (IP www.epfindia.gov.

in
Address:10.70.13.100)

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 - 9962724872
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100451580467
3. Name of the member J DINESH BABU

4. Date of Joining 01-Apr-2022


5. Date of Leaving Service/ NksM+us dk fnukad 03-Feb-2025
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 ATPPD6056P

8. Payee Address 47 NALEESWARAR


NAGAR,CHENNAI,KANCHEEPURAM,TAMIL
NADU-600069

* 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: Jothilingam Date Of Birth: 01-Jun-1991
Bank Account Number 30863043041 Bank IFSC Code SBIN0015055
Bank Details STATE BANK OF INDIA,KUNDRATHUR
Aadhaar 31XXXXXXXX45
Member ID THTHA00997420000029297
* —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.

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