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Dee

The document is an online submission for a PF Final Settlement application under the Employees' Provident Fund Scheme and Pension Scheme. It includes personal details of the member, Shyam, along with UAN, dates of joining and leaving service, and bank account information. The application confirms that all data on the Member Portal is correct and requests payment to the specified bank account.

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bitsc92
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4 views1 page

Dee

The document is an online submission for a PF Final Settlement application under the Employees' Provident Fund Scheme and Pension Scheme. It includes personal details of the member, Shyam, along with UAN, dates of joining and leaving service, and bank account information. The application confirms that all data on the Member Portal is correct and requests payment to the specified bank account.

Uploaded by

bitsc92
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 2026-06-16 19:19:50 (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 - 9625009094
Tracking ID : 10185588533301002
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101855885333
3. Name of the member SHYAM

4. Date of Joining 04-May-2023


5. Date of Leaving Service/ NksM+us dk fnukad 31-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 PLIPS2519Q

8. is Form-121 uploaded ? No

9. Payee Address wazirabad sector-


52,gurgaon,GURGAON,HARYANA-122003

* 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: BHUDDI Date Of Birth: 01-Jan-1998
Bank Account Number 52210058193594 Bank IFSC Code BDBL0001775
Bank Details BANDHAN BANK LIMITED,MAYUR VIHAR
Aadhaar 94XXXXXXXX73
Member ID DSNHP09405920000010494
* —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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