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UAN Based Form19

This document is an Employees' Provident Fund (EPF) Form 19 used to close an EPF account when an employee leaves employment. It requests information such as the employee's Universal Account Number (UAN), name, date of leaving, reason for leaving such as retirement or termination, permanent account number, address, and signature. The employee confirms the accuracy of their personal details linked to their UAN and that EPF settlement payment should be made to the bank account linked in their UAN portal account.

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Chandrasekhar Babu
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
122 views

UAN Based Form19

This document is an Employees' Provident Fund (EPF) Form 19 used to close an EPF account when an employee leaves employment. It requests information such as the employee's Universal Account Number (UAN), name, date of leaving, reason for leaving such as retirement or termination, permanent account number, address, and signature. The employee confirms the accuracy of their personal details linked to their UAN and that EPF settlement payment should be made to the bank account linked in their UAN portal account.

Uploaded by

Chandrasekhar Babu
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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www.epfindia.gov.

in

Employees Provident Fund Scheme, 1952


Form - 19 (UAN)
(Applicable in cases where employees complete details in Form 11 (New), Aadhaar Number and Bank
Accounts details are available on UAN Portal and UAN has been activated)
Mobile Number
1

Universal Account Number (UAN)

Name (In capital letters)

Date of Leaving

Reason of Leaving Service


(Tick the appropriate for TDS
purposes)

*Permanent Account Number


(PAN)

(a)
(b)
(c)
(d)
(e)

Superannuation
Cessation
Resignation
Disablement
Termination
a. Ill health
b. Contraction/Discontinuation of employers business
c. Causes beyond the control of employees
d. Personal reasons
(f) Marriage
(g) Permanent settlement abroad

Whether submitting Form


15G/15H, if applicable (YES/NO)
Please enclosed two copies of
Form No. 15G/15H, if applicable
*Only in case of service less than 5
years

Full postal address


Pincode:
*I certify that I have gone through the data seeded in UAN Portal and found all data including
Form No.11 (New), bank account details and Aadhar number.
* Please make payment in the bank account mentioned in the UAN portal. A cancelled cheque
(containing members name, bank account number and IFS Code) is attached herewith.

Signature of the Member

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