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The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Yatendra Pratap Singh on March 19, 2025. It includes personal details such as UAN, date of joining, date of leaving service, reason for leaving, and bank account information. The member certifies that all data in the Member Portal is correct and requests payment to the specified bank account.

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pyatendra5
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30 views2 pages

PDF Download

The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Yatendra Pratap Singh on March 19, 2025. It includes personal details such as UAN, date of joining, date of leaving service, reason for leaving, and bank account information. The member certifies that all data in the Member Portal is correct and requests payment to the specified bank account.

Uploaded by

pyatendra5
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 2025-03-19 09:12:53 (IP www.epfindia.gov.

in
Address:152.58.66.41)

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 - 9456035328
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101688091098
3. Name of the member YATENDRA PRATAP SINGH

4. Date of Joining 01-Apr-2022


5. Date of Leaving Service/ NksM+us dk fnukad 30-Nov-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 LFBPS4180J

8. Payee Address 185, Kamla Nagar Civil


Lines,Etah,ETAH,UTTAR PRADESH-207001

* 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: PREM KUMAR SINGH Date Of Birth: 03-Nov-1998
Bank Account Number 50100560510126 Bank IFSC Code HDFC0000870
Bank Details HDFC BANK,AGRA
Aadhaar 42XXXXXXXX21
Member ID MRAGR00028620000025264
* —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 .
UAN - 101688091098 Tracking ID - 10168809109801001

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