4/14/2019 EPFO: Collect Online Claim Receipt

UAN: 100914823260 ×

Please choose claim form type: PF Withdrawal / PF Advance / Pension Withdrawal

मोबाइल नंबर/Mobile Number 99XXXXXX34

यू नवसल खाता सं या/Universal Account 100914823260

Number (UAN)

बड़े अ र म नाम/Name (In capital letters) RAJENDER

* थायी खाता सं या (पैन)/*Permanent Account BMKXXXXX7P

Number (PAN)

Date Of Joinng 01-08-2016

छोड़ने का दनांक/Date of Leaving 31-03-2018

सेवा छोड़ने का कारण/Reason of Leaving Service* CESSATION (SHORT SERVICE)

I want to apply for ONLY PENSION WITHDRAWA

Employee Address C7/133 SULTANPURI   

DELHI : 110086
 
DELHI   

NORTH WEST
 
Delhi   

110086

*म मा णत करता हूँ क मने यू ए एन पोटल पर सीड डाटा को भल भाँ त दे ख लया है तथा फाम न. 11 नया बक खाता
ववरण और आधार सं या स हत सभी डाटा सह पाया गया है ।
I certify that I have gone through the data seeded in UAN Portal and found all data Close
including Form
No.11(New), bank account details and Aadhaar number.

  I am applying for this claim using my Aadhaar credentials. Certified that the particulars are true to the
best of my knowledge. I further certify that I have gone through the data seeded in UAN Portal against my
UAN and found all data, Bank Account Details (Bank Account and IFSC) and Aadhaar number, PAN to be
correct and these belong to me. Please make the payment into the bank account mentioned in the UAN
Portal. In case the amount is used for any purpose stated in column (6) above, I am liable to return the
entire amount with penal interest.

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4/14/2019 EPFO: Collect Online Claim Receipt

SUCCESS: OTP has been sent on Mobile Number *******3534 (Registered With UIDAI)
UAN: 100914823260
Resend OTP ×
(NOTE: OTP Will Be Send To Mobile Number Register With UIDAI (AADHAAR).)

Enter OTP 717739

OTP Has Been Verified , eKYC Updated And PF Final Withdrawal Claim Form Submitted Successfully
On Unified Portal. Please Click Here to view pdf

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