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document mithila pension

The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted by Mithila Kumari Pandit on April 2, 2025. It includes personal details such as UAN, date of joining and leaving service, and bank account information. The form certifies that all data is correct and requests payment to the specified bank account without the need for additional documentation due to prior online verification.

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grandhyattgoab
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9 views1 page

document mithila pension

The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted by Mithila Kumari Pandit on April 2, 2025. It includes personal details such as UAN, date of joining and leaving service, and bank account information. The form certifies that all data is correct and requests payment to the specified bank account without the need for additional documentation due to prior online verification.

Uploaded by

grandhyattgoab
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Submitted online at Member e-seva portal on 2025-04-02 17:02:46 (IP www.epfindia.gov.

in
Address:10.70.13.100)

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 - 9168394130
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101713952682
3. Name of the member MITHILA KUMARI PANDIT

4. Date of Joining 03-Aug-2021


5. Date of Leaving Service/ NksM+us dk fnukad 30-Oct-2024
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 DUXPP2979B

8. Payee Address Flat No 6 2nd Floor Correa


Appartment,New Vaddem Vasco Da
Gama,SOUTH GOA,GOA-403802

* 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: HARERAM Date Of Birth: 02-Apr-1995
Bank Account Number 265101513946 Bank IFSC Code ICIC0002651
Bank Details ICICI BANK LIMITED,VERNA
Aadhaar 57XXXXXXXX54
Member ID GAGOA00108520000012705
* —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.

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