Submitted online at Member e-seva portal on 2025-09-02 11:56:59 (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 - 9777437217
Tracking ID : 10125185107201001
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101251851072
3. Name of the member HARISCHANDRA PADHY
4. Date of Joining 15-Mar-2025
5. Date of Leaving Service/ NksM+us dk fnukad 30-Jun-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 DAQPP8931K (Not Verified: Not in ITD
Database)
8. Payee Address Gothagaon
Gothagam,Patrapur,GANJAM,ODISHA-
761037
* 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: MADHAB PADHY Date Of Birth: 05-Nov-1980
Bank Account Number 099212010002450 Bank IFSC Code UBIN0809926
Bank Details UNION BANK OF INDIA,KALABADA
Aadhaar 26XXXXXXXX31
Member ID MHBAN01290910001589962
* —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.
