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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 Jaydev Kumar Joshi, who is applying for a retirement-related withdrawal. It includes personal details such as UAN, date of joining and leaving service, and bank information. The claim is verified online, and no additional documentation is required for the bank details.

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girishjain314
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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 Jaydev Kumar Joshi, who is applying for a retirement-related withdrawal. It includes personal details such as UAN, date of joining and leaving service, and bank information. The claim is verified online, and no additional documentation is required for the bank details.

Uploaded by

girishjain314
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 2025-04-13 18:28:38 (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 - 7023611726
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101306058694
3. Name of the member JAYDEV KUMAR JOSHI

4. Date of Joining 02-Jan-2024


5. Date of Leaving Service/ NksM+us dk fnukad 31-Oct-2024
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k RETIREMENT

7. Permanent Account number / LFkk;h [kkrk la[;k ARLPJ9677J

8. Payee Address ward no 05


ganoda,Banswara,BANSWARA,RAJASTHAN
-327021

* 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: HEMENT KUMAR JOSHI Date Of Birth: 08-Apr-1990
Bank Account Number 61323753806 Bank IFSC Code SBIN0031941
Bank Details STATE BANK OF INDIA,MORDI
Aadhaar 80XXXXXXXX74
Member ID DSNHP09397090000036011
* —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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