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PF Advance Claim Form Submission Guide

The document is an online application submitted for a PF Advance of Rs 5000 by Nisha Devi, citing illness as the purpose. It includes details such as the Universal Account Number, mobile number, and bank account information for electronic payment. The application confirms that all provided information is accurate and acknowledges the responsibility for any misuse of the funds.

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mangilaljakhar012
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8 views1 page

PF Advance Claim Form Submission Guide

The document is an online application submitted for a PF Advance of Rs 5000 by Nisha Devi, citing illness as the purpose. It includes details such as the Universal Account Number, mobile number, and bank account information for electronic payment. The application confirms that all provided information is accurate and acknowledges the responsibility for any misuse of the funds.

Uploaded by

mangilaljakhar012
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 2025-11-06 17:10:11 (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 - 7807819599
Tracking ID : 10217371324706001
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 102173713247
3. Name of the member NISHA DEVI

4. Date of Joining 01-Mar-2025


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

6.a Purpose of Advance Illness

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 Village Marranwala Post office Nanakpur


,kalka,PANCHKULA,HARYANA-134102

Father/Husband/Spouse Name: SANJU LAL Date Of Birth: 13-Jul-1991


Bank Account Number 60527316689 Bank IFSC Code MAHB0002244
Bank Details BANK OF MAHARASHTRA,BADDI
Aadhaar 43XXXXXXXX21
Member ID HPSML32555770000010260
*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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