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The document is an online application for a PF Advance submitted by Deepak Gajanan Jondhale on March 1, 2026, through the Member e-seva portal. The application requests an advance of Rs 4000 for the purpose of illness, with all necessary details including UAN, PAN, and bank information provided. The applicant certifies the accuracy of the information and acknowledges the conditions for the advance payment.

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Deepak Jondhale
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9 views1 page

PDF Download

The document is an online application for a PF Advance submitted by Deepak Gajanan Jondhale on March 1, 2026, through the Member e-seva portal. The application requests an advance of Rs 4000 for the purpose of illness, with all necessary details including UAN, PAN, and bank information provided. The applicant certifies the accuracy of the information and acknowledges the conditions for the advance payment.

Uploaded by

Deepak Jondhale
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

Submitted online at Member e-seva portal on 2026-03-01 07:51:18 (IP [Link].

in
Address:[Link])

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 Member Portal and UAN has been activated.)
Mobile Number / eksckby uacj - 8237518070
Tracking ID : 10208266784806010
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 102082667848
3. Name of the member DEEPAK GAJANAN JONDHALE

4. Date of Joining 08-Mar-2023


5. Permanent Account number / LFkk;h [kkrk la[;k CHYPJ1019B

6.a Purpose of Advance Illness

6.b Amount of Advance (In Rs) 4000


7 In case of Advance for purpose of Site/House/Flat Not Applicable

8 Bankers details for Electronic Payment (Only for the Advance if payable to Not Applicable
third party)

9. Payee Address Wadali Amravati ,Amravati


,AMRAVATI,MAHARASHTRA-444602

Father/Husband/Spouse Name: GAJANAN Date Of Birth: 31-Oct-1996


Bank Account Number 8645557170 Bank IFSC Code KKBK0002048
Bank Details KOTAK MAHINDRA BANK LIMITED,AMRAVATI BRANCH
Aadhaar 42XXXXXXXX30
Member ID PUPUN03071480000099025
*Certified that the particulars are true to the best of my knowledge, I certify that I have gone through the data
seeded in Member portal and found all data, including Form No 11 (New), Bank Account details and Aadhaar number
to be correct. Please make the payment in the bank account mentioned in the Member Portal. In case the amount is
used for any purpose other than stated in column (6) above, I am liable to return the entire amount with penal
interest.
* —i;k ;w-,-,u-iksVZy ij n'kkZ, x, cSad [kkrs esa Hkqxrku djsaA
* Please make payment in the bank account mentioned in the Member portal .
* The bank kyc has been online verified by bank and has been digitally signed by the employer for this case among
other validations and therefore mandatory uploading of the image of cheque leaf/attested bank passbook is not
required.

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