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Submitted online at UAN e-seva portal on 2017-10-03 22:24:48.0 www.epfindia.gov.

in

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 lf; 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 - 9703144800
1. I want to apply for PF Final Settlement
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100283516892
3. Name of the member Pylas Yashwanth Vamsi
4. Date of Joining 01-Feb-13
5. Date of Leaving Service/ NksM+us dk fnukad 15-May-17
6. Reason of Leaving Service/ lsok NksM+us dk dkj.k CESSATION (SHORT SERVICE)
7. Permanent Account number / LFkk;h [kkrk la[;k BAZPP2109P

8. Payee Address Garemella apts , flat no 201, official colony


2nd
lane,visakhapatnam,VISAKHAPATNAM,AN

* eSa ekf.kr djrk gw fd eSaus ;w , ,u iksVZy ij lhM MkVk dks Hkyh Hkkfr 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: P TATA RAO Date Of Birth: 26-Oct-87
Bank Account Number 07631140012595 Bank IFSC Code HDFC0000763
Bank Details HDFC BANK,JHARSUGUDA - ORISSA
Aadhaar 85XXXXXXXX54
Member ID DLCPM00393710000001325
* 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 .