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The document is a submission of a UAN Based Combined Claim Form for PF Final Settlement by a member named Manjula Hanamantappa Vaddar. It includes details such as the member's UAN, dates of joining and leaving service, reason for leaving, and bank account information. The claim was submitted online through the Member e-seva portal on May 27, 2025, and confirms that all data in the Member Portal is correct.

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kalyanabhismac02
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2 views1 page

pf wid

The document is a submission of a UAN Based Combined Claim Form for PF Final Settlement by a member named Manjula Hanamantappa Vaddar. It includes details such as the member's UAN, dates of joining and leaving service, reason for leaving, and bank account information. The claim was submitted online through the Member e-seva portal on May 27, 2025, and confirms that all data in the Member Portal is correct.

Uploaded by

kalyanabhismac02
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 2025-05-27 11:20:05 (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 - 9686433725
Tracking ID : 10164549667501001
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101645496675
3. Name of the member MANJULA HANAMANTAPPA VADDAR

4. Date of Joining 10-Feb-2023


5. Date of Leaving Service/ NksM+us dk fnukad 20-Mar-2025
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 BDHPV6935L

8. Payee Address krishnapur


kadkol,HAVERI,HAVERI,KARNATAKA-
581118

* 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: HANUMANTHAPPA Date Of Birth: 07-May-1998
Bank Account Number 9522500101434101 Bank IFSC Code KARB0000952
Bank Details KARNATAKA BANK LIMITED,BENGALURU WHITEFIELD
Aadhaar 64XXXXXXXX02
Member ID THVSH01176780000903470
* —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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