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This document is a submission of a UAN Based Combined Claim Form for Pension Fund Withdrawal by member L Kavitha, detailing her employment and personal information. It includes her Universal Account Number, dates of joining and leaving service, and bank details for payment. The submission confirms that all data in the Member Portal is correct and that the bank KYC has been verified online.

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16 views1 page

Document

This document is a submission of a UAN Based Combined Claim Form for Pension Fund Withdrawal by member L Kavitha, detailing her employment and personal information. It includes her Universal Account Number, dates of joining and leaving service, and bank details for payment. The submission confirms that all data in the Member Portal is correct and that the bank KYC has been verified online.

Uploaded by

safetyhseh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Submitted online at Member e-seva portal on 2025-05-21 16:28:20 (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 - 6363175799
Tracking ID : 10210583410604001
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 102105834106
3. Name of the member L KAVITHA

4. Date of Joining 05-Aug-2024


5. Date of Leaving Service/ NksM+us dk fnukad 19-Dec-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 LITPK3401R

8. Payee Address 9th ward SL


Chowki,hospet,BELLARY,KARNATAKA-
583201

* 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: LOKESH Date Of Birth: 01-Jan-1998
Bank Account Number 1039104000151160 Bank IFSC Code IBKL0001039
Bank Details IDBI BANK,HOSPET
Aadhaar 36XXXXXXXX10
Member ID PYKRP20156760000012754
* —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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