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    of 2

    Submitted online at UAN e-seva portal on 2023-10-10 13:08:35 (IP www.epfindia.gov.

    in
    Address:152.58.197.53)

    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 - 9353050141
    1. I want to apply for PF Final Settlement
    2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100752631091
    3. Name of the member BEEDAM KARTHEEK

    4. Date of Joining 17-Nov-2022


    5. Date of Leaving Service/ NksM+us dk fnukad 30-Jun-2023
    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 CTFPK5126F

    8. Payee Address HIG 55 SINGAPORE TOWNSHIP


    PULTALMPALLI,KADAPA,YSR DISTRICT,
    KADAPA (CUDDAPAH),ANDHRA PRADESH-

    * 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: BEEDAM VIJAYA KUMAR Date Of Birth: 06-Sep-1991
    Bank Account Number 32619070446 Bank IFSC Code SBIN0015248
    Bank Details STATE BANK OF INDIA,I.T.I CIRCLE BRANCH
    Aadhaar 42XXXXXXXX56
    Member ID WBPRB00535100000048812
    * —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 - 100752631091 Tracking ID - 10075263109101001

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