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The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Ashish Singh on July 27, 2025. It includes personal details such as UAN, date of joining, date of leaving service, and bank account information. The claim is certified as correct and payment is requested to be made to the specified bank account.

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49 views1 page

PDF Download

The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Ashish Singh on July 27, 2025. It includes personal details such as UAN, date of joining, date of leaving service, and bank account information. The claim is certified as correct and payment is requested to be made to the specified bank account.

Uploaded by

niharmehta649
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 2025-07-27 20:34:21 (IP www.epfindia.gov.

in
Address:10.70.13.115)

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 - 7909041295
Tracking ID : 10135278396701001
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101352783967
3. Name of the member ASHISH SINGH

4. Date of Joining 21-Oct-2024


5. Date of Leaving Service/ NksM+us dk fnukad 23-May-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 FYXPS8565J

8. Payee Address warda 10,baluan Gayghat


road,brahampur,BUXAR,BIHAR-802130

* 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: ARVIND SINGH Date Of Birth: 07-Jun-1994
Bank Account Number 166801502275 Bank IFSC Code ICIC0001668
Bank Details ICICI BANK LIMITED,BANGALORE - INDIRANAGAR 12TH MAIN,
Aadhaar 86XXXXXXXX85
Member ID PYBOM26564410000010131
* —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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