Please choose claim form type: PF Withdrawal / PF Advance / Pension
Withdrawal
मोबाइल नंबर/Mobile Number 600175XXXX
यूिनवसर्ल खाता संख्या/Universal Account 101704919535
Number (UAN)
बड़े अक्षरों में नाम/Name (In capital letters) ABDUL AZIZ TALUKDAR
*स्थायी खाता संख्या (पैन)/*Permanent Account XXAPT571XX
Number (PAN)
Date Of Joinng 01-06-2021
छोड़ने का िदनांक/Date of Leaving 28-02-2025
सेवा छोड़ने का कारण/Reason of Leaving CESSATION (SHORT SERVICE) - Any other
Service* reason
I want to apply for ONLY PENSION WITHDRAWAL (FORM-10C)
Employee Address* Peenya 2nd stage
Andhrali main Road
KARNATAKA
BENGALURU (BANGALORE) URBAN
Bangalore
560058
Upload Scanned
EMPLOYEES' PROVIDENT copy of The bank
FUND ORGANISATION, kyc has been online verified by
INDIA
:
cheque/passbook bank and has been digitally signed by the
UAN: 101704919535
MINISTRY OF LABOUR & EMPLOYMENT, GOVERNMENT OF INDIAfor this case among other
employer
UAN : 1017 0491 9535 /ABDUL AZIZ TALUKDAR
validations and therefore mandatory
-A A A+ Logout
uploading of the image of cheque
Submitted online at Member e-seva portal on 2025-05-29 18:25:24 (IP leaf/attested
www.epfindia.gov.in bank passbook is not
Address:10.70.13.100)
required.
deZpkjh Hkfo"; fuf/k ;kstuk] 1952
EMPLOYEES' PROVIDENT FUND SCHEME,1952
*मैं प्रमािणत करता हूँ िक मैंने यू ए एन पोटर्ल पर सीड डाटा को भली भाँित दे ख िलया है तथा फामर् न. 11 नया बैंक
EMPLOYEES' Pension Scheme,1995
UAN Based Combined Claim Form 19/10C WB/31 for Advances/PF Final Settlement/Pension Fund Withdrawal
खाता aिववरण
mu ekeyksa esa ykxw tgka QkeZ 11(u;k)es deZpkjh dkऔर आधार
iwjk fooj.k] संख्य
vk/kkj la[;kा सिहत
vkSj cSad सभी
[kkrk laडाटा सही iksपाया
[;k ;w-,-,u- VZy vkSjगया
ij है।
miyC/k gS rFkk ;w-,-,u- esa lfØ; gSA)
Applicable in cases whereI employee's
certify that I have
complete detailsgone
in Formthrough
11(New),Aadhaar the data
Numberseeded
and Bank in UAN Portal and found all data
Accounts details are available on Member Portal and UAN has been activated.)
including Form No.11(New),
Mobile Number / eksckby bank uacj - account details and Aadhaar number.
6001757115
Tracking ID : 10170491953504001
. I want to apply for Pension Fund Withdrawal
मैं अपनी पहचान स्थािपत करने और ऑनलाइन दावा प्रस्तुत करने के के उद्देश्य से आधार आधािरत प्रमाणीकरण
. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101704919535
. Name of the member ABDUL AZIZ TALUKDAR
के िलए अपना आधार नंबर, बायोमेिट्रक और/या वन टाइम िपन (ओटीपी) डेटा प्रदान करने के िलए सहमत हूं
. Date of Joining 01-Jun-2021
I hereby consent to provide my Aadhaar Number, Biometric and/or One Time Pin (OTP)
. Date of Leaving Service/ NksM+us dk fnukad 28-Feb-2025
. data for Aadhaar based authentication
Reason of Leaving Service/ lsok NksM+us dk dkj.k for the
CESSATION (SHORT SERVICE)
reason
- Anypurpose
other of establishing my identity
. Permanent Account number / LFkk;h [kkrk la[;k BXAPT5718G
OTP has been verified , eKYC updated and Pension Withdrawal Claim form submitted
. Payee Address successfully onPeenya
Unified
2nd stagePortal. Please
Andhrali main Road
,Bangalore,BENGALURU (BANGALORE)
CLICK HERE to view pdf
URBAN,KARNATAKA-560058
ekf.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
lfgr lHkh MkVk lgh ik;k x;k gSA
ertify that I have gone through the data seeded in Member Portal and found all data including Form
11 (New) , bank account details and Aadhar Number to be correct
er/Husband/Spouse Name: ABDUL SHOHID TALUKDAR Date Of Birth: 18-Jan-2002
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k Account Number 13450100018533 Bank IFSC Code BARB0KATIGO
k Details BANK OF BARODA,KATIGORA, DIST CACHAR
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mber ID PYPNY00313470000012249
;k ;w-,-,u-iksVZy ij n'kkZ, x, cSad [kkrs esa Hkqxrku djsaA
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ease make payment in the bank account mentioned in the Member portal .
e bank kyc has been online verified by bank and has been digitally signed by the employer for this case among
r validations and therefore mandatory uploading of the image of cheque leaf/attested bank passbook is not
ired.
:
