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This document is a UAN-based combined claim form submitted online for pension fund withdrawal. It provides details of the applicant such as name (Anshu Gupta), UAN, date of joining service (24-Jun-2013), date of leaving service (03-Mar-2015), reason for leaving (cessation of short service), permanent account number, address, father's name, date of birth, bank account details for payment, and Aadhaar number. The applicant certifies that all seeded data in the UAN portal including form 11, bank details, and Aadhaar number have been verified to be correct. The applicant requests that payment be made to the bank account mentioned in the UAN portal.

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Anshu Gupta
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63 views

Document

This document is a UAN-based combined claim form submitted online for pension fund withdrawal. It provides details of the applicant such as name (Anshu Gupta), UAN, date of joining service (24-Jun-2013), date of leaving service (03-Mar-2015), reason for leaving (cessation of short service), permanent account number, address, father's name, date of birth, bank account details for payment, and Aadhaar number. The applicant certifies that all seeded data in the UAN portal including form 11, bank details, and Aadhaar number have been verified to be correct. The applicant requests that payment be made to the bank account mentioned in the UAN portal.

Uploaded by

Anshu Gupta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Submitted online at UAN e-seva portal on 2019-11-21 12:51:56 www.epfindia.gov.

in

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 UAN Portal and UAN has been activated.)
Mobile Number / eksckby uacj - 8920681052
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100099969964
3. Name of the member ANSHU GUPTA
4. Date of Joining 24-Jun-2013
5. Date of Leaving Service/ NksM+us dk fnukad 03-Mar-2015
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k CESSATION (SHORT SERVICE)
7. Permanent Account number / LFkk;h [kkrk la[;k AKCPG5518K

8. Payee Address Geeta House 60 j Extension street no


6,Delhi,EAST,DELHI-110092

* 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 UAN Portal and found all data including Form No.11
(New) , bank account details and Aadhar Number to be correct
Father/Husband/Spouse Name: SUMER CHAND GUPTA Date Of Birth: 07-Apr-1980
Bank Account Number 20004040520 Bank IFSC Code SBIN0006499
Bank Details STATE BANK OF INDIA,LAXMI NAGAR
Aadhaar 27XXXXXXXX67
Member ID MRNOI00221760000005727
* —i;k ;w-,-,u-iksVZy ij n'kkZ, x, cSad [kkrs esa Hkqxrku djsaA
* Please make payment in the bank account mentioned in the UAN portal .
UAN - 100099969964 Tracking ID - 10009996996404003

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