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UAN-Based Pension Fund Withdrawal Form

The document is a claim form submitted through the UAN e-seva portal for withdrawing funds from the employee pension fund. It provides details of an individual named Rahul Sivashanmugamurthy who was employed from August 2019 to February 2020 and is applying to withdraw their pension funds after leaving employment. All personal details including bank account, Aadhaar number, and employment records match what is available in the UAN portal.

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rahul
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162 views2 pages

UAN-Based Pension Fund Withdrawal Form

The document is a claim form submitted through the UAN e-seva portal for withdrawing funds from the employee pension fund. It provides details of an individual named Rahul Sivashanmugamurthy who was employed from August 2019 to February 2020 and is applying to withdraw their pension funds after leaving employment. All personal details including bank account, Aadhaar number, and employment records match what is available in the UAN portal.

Uploaded by

rahul
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 2022-01-21 17:00:06 (IP www.epfindia.gov.

in
Address:60.243.7.254)

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 - 9600971114
1. I want to apply for Pension Fund Withdrawal
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101088921481
3. Name of the member RAHUL SIVASHANMUGAMURTHY

4. Date of Joining 01-Aug-2019


5. Date of Leaving Service/ NksM+us dk fnukad 22-Feb-2020
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 FXCPS7391A

8. Payee Address 26/1 Ambethkar new st


Pennathur,Vellore,VELLORE,TAMIL NADU-
632058

* 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: SIVASHANMUGAMURTHY Date Of Birth: 26-Dec-1991
Bank Account Number 190901501998 Bank IFSC Code ICIC0001909
Bank Details ICICI BANK LIMITED,SATHUVACHARI
Aadhaar 24XXXXXXXX54
Member ID PYBOM19849350000010495
* —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 .
UAN - 101088921481 Tracking ID - 10108892148104002

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