Submitted online at UAN e-seva portal on 2024-12-20 09:34:31 (IP www.epfindia.gov.
in
Address:171.61.4.227)
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 - 8770601448
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100602339383
3. Name of the member AKSHAY JOSHI
4. Date of Joining 03-Oct-2023
5. Date of Leaving Service/ NksM+us dk fnukad 19-Dec-2023
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 AYMPJ0538N
8. Payee Address 103, Shree Krishna Colony Ankpat
Marg,Ujjain,UJJAIN,MADHYA PRADESH-
456006
* 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: SHARAD JOSHI Date Of Birth: 16-Feb-1993
Bank Account Number 919010086957908 Bank IFSC Code UTIB0001932
Bank Details AXIS BANK,KANTHAL, UJJAIN (MP)
Aadhaar 25XXXXXXXX30
Member ID MHBAN02112730000715653
* —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 - 100602339383 Tracking ID - 10060233938304001
