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The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted online on December 23, 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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7 views1 page

PDF Download

The document is a UAN Based Combined Claim Form for Pension Fund Withdrawal submitted online on December 23, 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

eduvalleyprofessional
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 2025-12-23 00:38:58 [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 - 9526657606

1. I want to apply for Pension Fund Withdrawal


2. Universal Account Number(UAN) / 101980176698

3. Name of the member HRIDYA K P


4. Date of Joining 08-Aug-2023
5. Date of Leaving Service/ 26-Mar-2024

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


Any other reason
GREPP4765E
7. Permanent Account number

8. Payee Address Odanavtom ,,Kottarakkara ,681,14-


691512

* 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: RAMACHANDRAN K P Date of Birth 18-May-1998


Bank Account Number 12240100276847 Bank IFSC Code FDRL0001224
Bank Details FEDERAL BANK,ODANAVATTOM
Aadhaar 53XXXXXXXX83
Member ID KRKCH000442900A0054797

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

EPFO UMANG

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