Submitted online at Member e-seva portal on 2025-10-26 17:12:06 (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 - 9873201568
Tracking ID : 10030790888606003
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 100307908886
3. Name of the member RANJEET SINGH
4. Date of Joining 01-Nov-2011
5. Permanent Account number / LFkk;h [kkrk la[;k EAXPS1604F
6.a Purpose of Advance Illness
6.b Amount of Advance (In Rs) 35000
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 boga,Mainpuri
Mainpuri,Mainpuri,MAINPURI,UTTAR
PRADESH-205001
Father/Husband/Spouse Name: HARDAYAL SINGH Date Of Birth: 01-Jan-1988
Bank Account Number 21350100034001 Bank IFSC Code BARB0TRDCHW
Bank Details BANK OF BARODA,CHOWKBARA-NEW DELHI
Aadhaar 79XXXXXXXX36
Member ID DSNHP00299580000008272
*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.