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The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Vinayak Prahlad Suryavanshi on June 4, 2025. It includes personal details, employment history, and banking information necessary for processing the claim. The claim is certified as accurate and the bank details have been verified online, eliminating the need for additional documentation.

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Vinayak Suryavanshi
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37 views1 page

PDF Download

The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Vinayak Prahlad Suryavanshi on June 4, 2025. It includes personal details, employment history, and banking information necessary for processing the claim. The claim is certified as accurate and the bank details have been verified online, eliminating the need for additional documentation.

Uploaded by

Vinayak Suryavanshi
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 2025-06-04 12:09:31 (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 - 7218405451
Tracking ID : 10101704322901002
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101017043229
3. Name of the member VINAYAK PRAHLAD SURYAVANSHI

4. Date of Joining 16-Mar-2022


5. Date of Leaving Service/ NksM+us dk fnukad 31-Jan-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 CFIPS2297Q

8. Payee Address SHAHAPUR


SHAHAPUR,SHAHAPUR,SATARA,MAHARAS
HTRA-415115

* 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: PRAHLAD Date Of Birth: 18-Jun-1985
Bank Account Number 50100679824873 Bank IFSC Code HDFC0003158
Bank Details HDFC BANK,KALAMBI
Aadhaar 99XXXXXXXX56
Member ID BGMRD16820840000011208
* —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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