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PF Form (Aadhar - Non Aadhar)

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vaibhav singh
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110 views5 pages

PF Form (Aadhar - Non Aadhar)

Uploaded by

vaibhav singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Mobile Number

EMPLOYEES' PROVIDENT FUNDS ORGANISATION


COMPOSITE CLAIM FORM (AADHAR)

(APPLICABLE IN CASES WHERE EMPLOYEES' COMPLETE DETAILS IN FORM-11 (NEW), AADHAR NUMBER AND BANK ACCOUNT DETAILS ARE AVAIALABLE ON UAN
PORTAL AND UAN HAS BEEN ACTIVATED)

[FORM NO. - 19 (PF FINAL SETTLEMENT)/10C (PENSION WITHDRAWAL BENEFITS)/ 31 (PF PART WITHDRAWAL)]

Claim applied for i) Final PF Settlement ( ) ii) Pension Withdrawal Benefits ( ) iii) PF PART WITHDRAWAL ( )
1 (Tick whichever is/are applicable)

2 Name of the member (IN CAPITAL LETTERS)


3 a) Universal Account Number(UAN) a)
4 Aadhar Number
5 Date of joining the establishment

6 a) Purpose of PF Part Withdrawal(Tick P whichever applicable) SN Purpose of PF Part Withdrawal P


Housing Loan/Purchase of site/House/Flat or
b) Amount (in Rs.): _________________________________ for Construction/Addition, alteration in existing
i house/Repayment of Housing loan
(Para 686/68BB/68BC)
c) For purpose of Site/House/Flat or Construction through "agency" or
Repayment of Housing Loan or LIC, indicate cheque to be drawn " ii Lockout or clousure of factory (para 68H)
in favour of" and payee's address. iii Illness of member/family (Para 68J)

iv Marriage of self/son/daughter/brother/sister
(Para 68K)

v Post Matriculation education of children


(Para 68K)
vi Natural calamity (Para 68L)

vii Cut in electricity in establishment


(Para68M)
viii Advance for Physically handicapped (Para 68N)
ix One year before retirement (Para 68NN)
Investment in Varistha Pension BimaYojana
x (Para 68NNN)

7 Date of leaving service (not required if applying for PF Part Withdrawal)

8 a) Permanent Account No.(PAN) (Only in case of service less than 5 years)


(Please enclose two copies of Form No. 15G/15H, if applicable)
b) Reason of leaving Service
- Service terminated on account of (a) ill health of member
(b)Contraction /Discontinuation of employer's business or
(c) Other Cause beyond the control of the member
- Personal Reasons

9 Full Postal address

Pin

- Certified that the particulars are true to the best of my knowledge. 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. Please make the payment in the bank account mentioned in the
UAN Portal. A cancelled cheque (containing member's name, bank account number and IFS Code) is attached herewith.

- In case the amount is used for any purpose other than stated in column (6) above, I am liable to return the entire amount with penal interest.

Member's Signature
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Mobile Number
EMPLOYEES' PROVIDENT FUNDS ORGANISATION
COMPOSITE CLAIM FORM (NON-AADHAR)

[FORM NO. - 19 (PF FINAL SETTLEMENT)/10C (PENSION WITHDRAWAL BENEFITS)/ 31 (PF PART WITHDRAWAL)]

Claim applied for i) Final PF Settlement ( ) ii) Pension Withdrawal Benefits ( ) iii) PF PART WITHDRAWAL ( )
1 (Tick whichever is/are applicable)

2 Name of the member (IN CAPITAL LETTERS)


a) Universal Account Number(UAN) a)
3
b) P.F. Account No.(in case UAN not available) b)
4 Aadhar Number (for seeding)
a) Father's Name a)
5
b) Husband's Name b)
6 Date of Birth
7 Date of joining the establishment
8 Date of leaving service (not required if applying for PF Part Withdrawal)

9 a) Permanent Account No.(PAN) (Only in case of service less than 5 years)


(Please enclose two copies of Form No. 15G/15H, if applicable)
b) Reason of leaving Service
- Service terminated on account of (a) ill health of member
(b)Contraction /Discontinuation of employer's business or
(c) Other Cause beyond the control of the member
- Personal Reasons

10 a) Purpose of PF Part Withdrawal(Tick P whichever applicable) SN Purpose of PF Part Withdrawal P


Housing Loan/Purchase of site/House/Flat or
b) Amount (in Rs.): _________________________________ for Construction/Addition, alteration in existing
i house/Repayment of Housing loan
(Para 686/68BB/68BC)
c) For purpose of Site/House/Flat or Construction through "agency" or
Repayment of Housing Loan or LIC, indicate cheque to be drawn " ii Lockout or clousure of factory (para 68H)
in favour of" and payee's address. iii Illness of member/family (Para 68J)

iv Marriage of self/son/daughter/brother/sister
(Para 68K)

v Post Matriculation education of children


(Para 68K)
vi Natural calamity (Para 68L)

vii Cut in electricity in establishment


(Para68M)
viii Advance for Physically handicapped (Para 68N)
ix One year before retirement (Para 68NN)
Investment in Varistha Pension BimaYojana
x (Para 68NNN)

11 Bank Account details for payment Saving Bank Account No.


(Please attach a copy of cancelled cheque/attested copy of first page of
Pass Book) Name& address of the Bank

IFSC Code
12 Full Postal address

Pin
- The member hereby declares that he has not been employed for two months (Yes/No.)
- Certified that the particulars are true to the best of my knowledge.
-In case the amount is used for any purpose other than stated in column (10) above, I am liable to return the entire amount with penal interest.

Employer's Signature
Member's Signature Designation& Seal of Employer
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