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The document is an online application for a PF Advance submitted by Nitesh Fuldas Shahare on December 13, 2025, for an amount of Rs 6000 due to illness. It includes personal details such as UAN, mobile number, and bank account information, confirming that all data is accurate and verified. The applicant certifies that the funds will be used for the stated purpose and acknowledges the obligation to return the amount if misused.

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New Seeta Public School Deori
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3 views1 page

Document

The document is an online application for a PF Advance submitted by Nitesh Fuldas Shahare on December 13, 2025, for an amount of Rs 6000 due to illness. It includes personal details such as UAN, mobile number, and bank account information, confirming that all data is accurate and verified. The applicant certifies that the funds will be used for the stated purpose and acknowledges the obligation to return the amount if misused.

Uploaded by

New Seeta Public School Deori
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 Member e-seva portal on 2025-12-13 11:07:39 (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 - 7666892671
Tracking ID : 10186097148206002
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101860971482
3. Name of the member NITESH FULDAS SHAHARE

4. Date of Joining 01-Aug-2022


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

6.a Purpose of Advance Illness

6.b Amount of Advance (In Rs) 6000


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 At Pandharwani Po Ta Deori dist Gondia


shedepar
road,Gondia,GONDIYA,MAHARASHTRA-

Father/Husband/Spouse Name: FULDAS SHAHARE Date Of Birth: 01-Jan-1991


Bank Account Number 97800100023251 Bank IFSC Code BARB0DBDORI
Bank Details BANK OF BARODA,DEORI
Aadhaar 46XXXXXXXX45
Member ID NGNAG14784330000010081
*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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