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10C

The document is an online submission for a Pension Fund Withdrawal under the Employees' Provident Fund Scheme and Employees' Pension Scheme. It contains the member's details, including their Universal Account Number, personal information, and bank account information. The submission confirms that all data is correct and requests payment to the specified bank account.

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infinityit0012
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8 views1 page

10C

The document is an online submission for a Pension Fund Withdrawal under the Employees' Provident Fund Scheme and Employees' Pension Scheme. It contains the member's details, including their Universal Account Number, personal information, and bank account information. The submission confirms that all data is correct and requests payment to the specified bank account.

Uploaded by

infinityit0012
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

Submitted online at Member e-seva portal on 2026-03-30 16:46:56 (IP [Link].

in
Address:[Link])

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 - 9146689206
Tracking ID : 10123362449304002
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101233624493
3. Name of the member AMBADAS BHAUSAHEB NIMBALKAR

4. Date of Joining 24-Jun-2024


5. Date of Leaving Service/ NksM+us dk fnukad 30-Dec-2025
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 APSPN7040N

8. Payee Address NEAR MARUTI MANDIR


TATHAWADE,PUNE,PUNE,MAHARASHTRA-
411033

* eSa ç[Link] 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: BHAUSAHEB Date Of Birth: 01-Jun-1970
Bank Account Number 510000000102310 Bank IFSC Code SRCB0000075
Bank Details SARASWAT COOPERATIVE BANK LIMITED,HINJEWADI
Aadhaar 72XXXXXXXX25
Member ID PUPUN00332990000756030
* —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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