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 UAN Portal and UAN has been activated.)
Mobile Number / eksckby uacj 9137390251
1.
I want to apply for
Pension Fund Withdrawal
2.
Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k
3.
Name of the member
4.
Date of Joining
15-Sep-2017
5.
Date of Leaving Service/ NksM+us dk fnukad
23-Mar-2019
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
BTQPJ8352N
8.
Payee Address
1/7 SHIVGARJANA CO OP HOUSING
SOCIETY CHIKANGHAR HIGHWAY
ROAD,KALYAN,THANE,MAHARASHTRA-
101178326711
SARVESH SANTOSH JADHAV
* eSa çekf.kr 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 UAN Portal and found all data including Form No.11
(New) , bank account details and Aadhar Number to be correct
Father/Husband/Spouse Name: SANTOSH
Date Of Birth: 24-Aug-1998
Bank Account Number
121510510002668
Bank IFSC Code
BKID0001215
Bank Details
BANK OF INDIA,MAHAD
Aadhaar
76XXXXXXXX39
MHBAN00472640000050015
Member ID
* —i;k ;w-,-,u-iksVZy ij n'kkZ, x, cSad [kkrs esa Hkqxrku djsaA
* Please make payment in the bank account mentioned in the UAN portal .