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UAN Pension Fund Withdrawal Application

The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted online on August 6, 2025. It includes details such as the member's name, UAN, dates of joining and leaving service, and bank account information. The applicant certifies that all data on the UAN portal is correct and requests payment to the specified bank account.

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shrivastavsatyam366
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17 views1 page

UAN Pension Fund Withdrawal Application

The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted online on August 6, 2025. It includes details such as the member's name, UAN, dates of joining and leaving service, and bank account information. The applicant certifies that all data on the UAN portal is correct and requests payment to the specified bank account.

Uploaded by

shrivastavsatyam366
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 UAN e-seva portal on 2025-08-06 12:08:48 [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 - 8954306924

1. I want to apply for Pension Fund Withdrawal


2. Universal Account Number(UAN) / 102106896602

3. Name of the member SATYAM SHRI VASTAV


4. Date of Joining 22-Jun-2024
5. Date of Leaving Service/ 31-May-2025

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


Any other reason
N.A.
7. Permanent Account number

8. Payee Address Nizampur ,Hapur ,Hapur,233,30-


245101

* 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: LAKSHMI KANT VASTAV Date of Birth 12-Dec-2005


Bank Account Number 60470835356 Bank IFSC Code MAHB0001880
Bank Details BANK OF
MAHARASHTRA,NIZAMPUR
Aadhaar 88XXXXXXXX90
Member ID MRNOI29106370000011477

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

EPFO UMANG

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