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UAN-Based PF Advance Claim Form

The document is an online submission for a PF Advance application under the Employees' Provident Fund Scheme, 1952. The member, Sainaba M, is requesting an advance of Rs 220,000 for purchasing a site for construction of a dwelling house, with all required details provided. The application includes personal information, bank details, and a certification of accuracy for the submitted data.

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Mithun N
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6 views2 pages

UAN-Based PF Advance Claim Form

The document is an online submission for a PF Advance application under the Employees' Provident Fund Scheme, 1952. The member, Sainaba M, is requesting an advance of Rs 220,000 for purchasing a site for construction of a dwelling house, with all required details provided. The application includes personal information, bank details, and a certification of accuracy for the submitted data.

Uploaded by

Mithun N
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 2025-02-14 13:53:32 (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 - 9605562229
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100327946240
3. Name of the member SAINABA M

4. Date of Joining 01-May-1982


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

6.a Purpose of Advance Purchase of Site for Construction of


Dwelling House

6.b Amount of Advance (In Rs) 220000


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 Alloor(h)


chulukka,Meppadi,WAYANAD,KERALA-
673577

Father/Husband/Spouse Name: MOIDU Date Of Birth: 03-Sep-1965


Bank Account Number 34681286832 Bank IFSC Code SBIN0070478
Bank Details STATE BANK OF INDIA,KOTTAPADI
Aadhaar 27XXXXXXXX59
Member ID KRKKD00004390000001144
*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. A cancelled cheque
(containing member's name, bank account number and IFS Code) is attached herewith. 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 .
UAN - 100327946240 Tracking ID - 10032794624006001

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