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UAN-Based PF Advance Claim Form

The document is a UAN Based Combined Claim Form for PF Advance submitted by a member named Vicky on March 17, 2025. The member is requesting an advance of Rs 6000 for medical expenses, with all necessary details including Aadhaar and bank information provided. The submission confirms that the information is accurate and requests payment to the specified bank account.

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vickysingh2001m
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8 views1 page

UAN-Based PF Advance Claim Form

The document is a UAN Based Combined Claim Form for PF Advance submitted by a member named Vicky on March 17, 2025. The member is requesting an advance of Rs 6000 for medical expenses, with all necessary details including Aadhaar and bank information provided. The submission confirms that the information is accurate and requests payment to the specified bank account.

Uploaded by

vickysingh2001m
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 2025-03-17 21:28:51 (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 - 8700244379
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101852548584
3. Name of the member VICKY

4. Date of Joining 05-Aug-2024


5. Permanent Account number / LFkk;h [kkrk la[;k CJRPV1617G

6.a Purpose of Advance Illness

6.b Amount of Advance (In Rs) 6000


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 B-15/9 street no 9 Gamri ext


bhajanpura,New delhi,NORTH EAST,DELHI-
110053

Father/Husband/Spouse Name: VIJAY RAJAK Date Of Birth: 20-Jul-2001


Bank Account Number 639502010018281 Bank IFSC Code UBIN0563951
Bank Details UNION BANK OF INDIA,GARHI MAINDU
Aadhaar 26XXXXXXXX76
Member ID DLCPM25322840000011670
*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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