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The document is an online submission of a UAN Based Combined Claim Form for PF Final Settlement by Amar Rana, with UAN 101830472780. It includes personal details such as the date of joining and leaving service, reason for leaving, and bank account information. The claim is submitted without a PAN, and the payment is requested to be made to the bank account linked in the UAN portal.

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dibyamay patra
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3 views1 page

PDF Download

The document is an online submission of a UAN Based Combined Claim Form for PF Final Settlement by Amar Rana, with UAN 101830472780. It includes personal details such as the date of joining and leaving service, reason for leaving, and bank account information. The claim is submitted without a PAN, and the payment is requested to be made to the bank account linked in the UAN portal.

Uploaded by

dibyamay patra
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

Submitted online at UAN e-seva portal on 2026-05-20 08:26:14 [Link].

in

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

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 - 9732904666

1. I want to apply for PF Final Settlement


2. Universal Account Number(UAN) / 101830472780

3. Name of the member AMAR RANA


4. Date of Joining 01-Jun-2022
5. Date of Leaving Service/ 06-Oct-2022

6. Reason of Leaving Service/ CESSATION (SHORT SERVICE) -


Any other reason
PAN NOT AVAILABLE ( Member
7. Permanent Account number opted to submit the online claim
without seeding PAN.)
8. Payee Address Alankarpur ,West Bengal ,Ramnagar
,795,31-721441

* 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: SAMARAN JIT RANA Date of Birth 02-Apr-1977


Bank Account Number 33300009757 Bank IFSC Code SBIN0001514
Bank Details STATE BANK OF INDIA,DIGHA
Aadhaar 86XXXXXXXX44
Member ID MHBAN00401510000012363

* Please make payment in the bank account mentioned in the UAN portal.

EPFO UMANG

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