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PF Final Settlementkamlesh

The document is an online submission for a PF Final Settlement claim under the Employees' Provident Fund Scheme and Pension Scheme. It includes personal details of the member, Kamlesh, such as UAN, dates of joining and leaving service, and bank account information. The claim is submitted without a PAN, and the bank details have been verified online, eliminating the need for additional documentation.

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girishjain314
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23 views1 page

PF Final Settlementkamlesh

The document is an online submission for a PF Final Settlement claim under the Employees' Provident Fund Scheme and Pension Scheme. It includes personal details of the member, Kamlesh, such as UAN, dates of joining and leaving service, and bank account information. The claim is submitted without a PAN, and the bank details have been verified online, eliminating the need for additional documentation.

Uploaded by

girishjain314
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 2025-07-24 13:17:01 (IP www.epfindia.gov.

in
Address:10.70.13.115)

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 - 9358950853
Tracking ID : 10067116507201002
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100671165072
3. Name of the member KAMLESH

4. Date of Joining 01-Mar-2016


5. Date of Leaving Service/ NksM+us dk fnukad 30-Mar-2020
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k RETIREMENT

7. Permanent Account number / LFkk;h [kkrk la[;k PAN NOT AVAILABLE ( Member opted to
submit the online claim without seeding
PAN.)

8. Payee Address ward no 10 timba


gamdi,Banswara,BANSWARA,RAJASTHAN-
327001

* 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: HARIYA Date Of Birth: 15-Jul-1996
Bank Account Number 01398100012113 Bank IFSC Code BARB0BANSWA
Bank Details BANK OF BARODA,BANSWARA BRANCH
Aadhaar 97XXXXXXXX01
Member ID RJUDR00082420000008699
* —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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