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35 views

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ajitrokhade
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Submitted online at UAN e-seva portal on 2024-04-20 19:29:23 (IP www.epfindia.gov.

in
Address:152.58.195.202)

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 - 8884490238
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100098069518
3. Name of the member Ajit Rokhade

4. Date of Joining 03-Dec-2018


5. Date of Leaving Service/ NksM+us dk fnukad 30-Sep-2019
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 AUSPR9972L

8. Payee Address 121,3rd main, 3rd cross, 6th block


Katriguppe ,Bangalore ,BENGALURU
(BANGALORE) URBAN,KARNATAKA-560085

* 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: Padmaraj Date Of Birth: 06-Feb-1979
Bank Account Number 02611140073570 Bank IFSC Code HDFC0000261
Bank Details HDFC BANK,BANGALORE - JAYANAGAR
Aadhaar 39XXXXXXXX47
Member ID PYKRP00077880000019374
* —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 - 100098069518 Tracking ID - 10009806951801005

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