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The document is a UAN Based Combined Claim Form for PF Advance submitted by Mandala Sandeep, requesting an advance of Rs 10,000 due to illness. The form includes personal details, bank information, and certification of data accuracy on the UAN portal. It specifies that payment should be made to the bank account listed in the UAN portal.

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sandeepmandala4
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2 views1 page

PDF Download

The document is a UAN Based Combined Claim Form for PF Advance submitted by Mandala Sandeep, requesting an advance of Rs 10,000 due to illness. The form includes personal details, bank information, and certification of data accuracy on the UAN portal. It specifies that payment should be made to the bank account listed in the UAN portal.

Uploaded by

sandeepmandala4
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 UAN e-seva portal on 2026-04-13 00:58:53 [Link].

in

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

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 - 8919480995

1. I want to apply for PF Advance


2. Universal Account Number(UAN) / 102203643674

3. Name of the member MANDALA SANDEEP


4. Date of Joining 07-May-2025
RRNPS4912N
5. Permanent Account number

6.a Purpose of Advance Illness


6.b Amount of Advance (In Rs) 10000
7. In case of Advance for purpose of Not Applicable
Site/House/Flat
8. Bankers details for Electronic Payment (Only for Not Applicable
the Advance if payable to third party)
9. Payee Address CHALLAPALLI ,NARAYANARAO
NAGAR,CHALLAPALLI ,628,1-
521126

* 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: BABUJI Date of Birth 08-Jun-2004


Bank Account Number 005501000032200 Bank IFSC Code IOBA0000055
Bank Details INDIAN OVERSEAS
BANK,MASULIPATNAM
Aadhaar 58XXXXXXXX75
Member ID THVSH00414420000471580

* Please make payment in the bank account mentioned in the UAN portal.

EPFO UMANG

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