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The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted by Vinay Kumar Sahu on May 26, 2026. It includes personal details such as UAN, date of joining, date of leaving service, and reasons for withdrawal. The claim is for taking employment abroad and confirms that all data in the Member Portal is accurate and verified by the bank.

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sahuvinay43000
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2 views1 page

Document

The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted by Vinay Kumar Sahu on May 26, 2026. It includes personal details such as UAN, date of joining, date of leaving service, and reasons for withdrawal. The claim is for taking employment abroad and confirms that all data in the Member Portal is accurate and verified by the bank.

Uploaded by

sahuvinay43000
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 2026-05-26 14:37:42 (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 - 7828263226
Tracking ID : 10227011115404001
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 102270111154
3. Name of the member Vinay Kumar Sahu

4. Date of Joining 09-Dec-2025


5. Date of Leaving Service/ NksM+us dk fnukad 16-Apr-2026
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k CESSATION (SHORT SERVICE) - Any other
reason

6.a Reason of Withdrawal TAKING EMPLOYMENT ABROAD

7. Permanent Account number / LFkk;h [kkrk la[;k RLYPS3648E

9. Payee Address ward 16 pisid pisid,kasdol,BALODA


BAZAR,CHHATTISGARH-493335

* 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: SANTOSH KUMAR Date Of Birth: 24-Mar-2007
Bank Account Number 44845417709 Bank IFSC Code SBIN0000336
Bank Details STATE BANK OF INDIA,BILASPUR MAIN
Aadhaar 22XXXXXXXX16
Member ID THVSH01176780001102454
* —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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