![Submitted online at UAN e-seva portal on 2018-04-15 18:45:20.0 www.epfindia.gov.in
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 - 7009259580
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100126074960
3. Name of the member CHITER REKHA
4. Date of Joining 03-Nov-2011
5. Date of Leaving Service/ NksM+us dk fnukad 30-Apr-2017
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k CESSATION (SHORT SERVICE)
7. Permanent Account number / LFkk;h [kkrk la[;k AXVPR7569M
8. Payee Address VPO LANA PALLAR TEHSIL
SANGRAH,RENUKA JI,SIRMAUR,HIMACHAL
PRADESH-173023
* 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: GUMAN SINGH Date Of Birth: 12-May-1992
Bank Account Number 36201526463 Bank IFSC Code ICIC0000362
Bank Details ICICI BANK LIMITED,CHANDIGARH - MANIMAJRA
Aadhaar 21XXXXXXXX70
Member ID PUPUN01206130000050692
* —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 .](https://image.slidesharecdn.com/pfform-180614050659/85/Pf-form-1-320.jpg)
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- 1. Submitted online at UAN e-seva portal on 2018-04-15 18:45:20.0 www.epfindia.gov.in 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 - 7009259580 1. I want to apply for Pension Fund Withdrawal 2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100126074960 3. Name of the member CHITER REKHA 4. Date of Joining 03-Nov-2011 5. Date of Leaving Service/ NksM+us dk fnukad 30-Apr-2017 6. Reason of Leaving Service/ lsok NksM+us dk dkj.k CESSATION (SHORT SERVICE) 7. Permanent Account number / LFkk;h [kkrk la[;k AXVPR7569M 8. Payee Address VPO LANA PALLAR TEHSIL SANGRAH,RENUKA JI,SIRMAUR,HIMACHAL PRADESH-173023 * 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: GUMAN SINGH Date Of Birth: 12-May-1992 Bank Account Number 36201526463 Bank IFSC Code ICIC0000362 Bank Details ICICI BANK LIMITED,CHANDIGARH - MANIMAJRA Aadhaar 21XXXXXXXX70 Member ID PUPUN01206130000050692 * —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 .