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The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Dilip Kumar Giri, who left service due to permanent disablement. It includes personal details, UAN, and bank information, confirming that all data on the UAN portal is correct. The claim was submitted online on April 30, 2024, and payment is requested to be made to the specified bank account.

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6 views2 pages

PDF Download

The document is a UAN Based Combined Claim Form for PF Final Settlement submitted by Dilip Kumar Giri, who left service due to permanent disablement. It includes personal details, UAN, and bank information, confirming that all data on the UAN portal is correct. The claim was submitted online on April 30, 2024, and payment is requested to be made to the specified bank account.

Uploaded by

nityagiri12921
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

Submitted online at UAN e-seva portal on 2024-04-30 11:18:31 [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 - 9696754839

1. I want to apply for PF Final Settlement


2. Universal Account Number(UAN) / 101751599877

3. Name of the member DILIP KUMAR GIRI


4. Date of Joining 23-Jun-2022
5. Date of Leaving Service/ 30-Nov-2023

6. Reason of Leaving Service/ PERMANENT DISABLEMENT


PAN NOT AVAILABLE ( Member
7. Permanent Account number opted to submit the online claim
without seeding PAN.)
8. Payee Address Barji ,Nayepur ,Varanasi ,291,30-
221207

* 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: MUTTHU Date of Birth 01-Jan-1995


Bank Account Number 39558906635 Bank IFSC Code SBIN0005472
Bank Details STATE BANK OF INDIA,ANNAI
Aadhaar 96XXXXXXXX67
Member ID DSNHP09406570000025304

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

EPFO UMANG
EPFO UMANG

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