Submitted online at Member e-seva portal on 2025-10-23 20:51:27 (IP [Link].
in
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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 - 9515687823
Tracking ID : 10139714438806020
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101397144388
3. Name of the member BONTHA ALEK BABU
4. Date of Joining 03-Feb-2025
5. Permanent Account number / LFkk;h [kkrk la[;k CXWPA4734Q
6.a Purpose of Advance Additions / Alterations of House
6.b Amount of Advance (In Rs) 5000
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 8-4-379/E NRR PURAM SITE 1 BORABANDA
HYDERABAD ,HYDERABAD
,HYDERABAD,TELANGANA-500018
Father/Husband/Spouse Name: BONTHA BABURAO Date Of Birth: 27-Aug-1994
Bank Account Number 1550043141 Bank IFSC Code KKBK0007469
Bank Details KOTAK MAHINDRA BANK LIMITED,SANATHNAGAR HYDERABAD
Aadhaar 58XXXXXXXX77
Member ID PUPUN16270670000013211
*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.
*It is declared that the above advance claimed under para 68B(7) of the EPF Scheme, 1952 is for carrying out
additions, substantial alterations or improvements necessary to the dwelling house owned by me/jointly by me and
my spouse. I further declare that I am applying for this withdrawal only after a period of 5 years from the date of
completion of the dwelling house.