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Jugal Ji Penshion

The document is an online submission for a Pension Fund Withdrawal by a member named Jugal Trivedi, with a Universal Account Number (UAN) of 101454035960. It includes personal details such as the member's joining and leaving dates, reason for leaving, and bank account information. The submission confirms that all data on the Member Portal is correct and that the bank details have been verified.

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girishjain314
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16 views1 page

Jugal Ji Penshion

The document is an online submission for a Pension Fund Withdrawal by a member named Jugal Trivedi, with a Universal Account Number (UAN) of 101454035960. It includes personal details such as the member's joining and leaving dates, reason for leaving, and bank account information. The submission confirms that all data on the Member Portal is correct and that the bank details have been verified.

Uploaded by

girishjain314
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 2025-04-25 22:09:04 (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 - 9602053012
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101454035960
3. Name of the member JUGAL TRIVEDI

4. Date of Joining 03-May-2019


5. Date of Leaving Service/ NksM+us dk fnukad 30-Jun-2022
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 BDUPT4711R

8. Payee Address laxminarayan chowk


padwa,Dungarpur,DUNGARPUR,RAJASTHA
N-314024

* 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: DINESH CHANDRA TRIVEDI Date Of Birth: 12-Sep-1990
Bank Account Number 4936000400128074 Bank IFSC Code PUNB0493600
Bank Details PUNJAB NATIONAL BANK,BANSWARA SYNTEX LTD,BANSWARA
Aadhaar 94XXXXXXXX66
Member ID RJUDR00028690000049002
* —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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