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UAN-Based PF Final Settlement Form

The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Tejinder Pal Singh on February 19, 2025. It includes personal details such as UAN, date of joining, date of leaving service, and bank information. The claim is for a final settlement due to cessation of service after a short duration of employment.

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Davinder Brar
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9 views1 page

UAN-Based PF Final Settlement Form

The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Tejinder Pal Singh on February 19, 2025. It includes personal details such as UAN, date of joining, date of leaving service, and bank information. The claim is for a final settlement due to cessation of service after a short duration of employment.

Uploaded by

Davinder Brar
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 2025-02-19 08:11:55 (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 - 9906016035
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100390281719
3. Name of the member TEJINDER PAL SINGH

4. Date of Joining 13-Feb-2023


5. Date of Leaving Service/ NksM+us dk fnukad 21-Feb-2024
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 BJZPS9723H

8. Payee Address Ward No 1, Bhour Camp, Jammu Bhore


Camp,Jammu,JAMMU,JAMMU AND
KASHMIR-181101

* 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: DEADAR SINGH Date Of Birth: 01-Feb-1979
Bank Account Number 911010062216980 Bank IFSC Code UTIB0001011
Bank Details AXIS BANK,G S MARG, JAMMU
Aadhaar 41XXXXXXXX17
Member ID RJRAJ00161550000077074
* —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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