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The document is an online application for a PF Advance submitted by a member named Satendra on January 5, 2026, for an amount of Rs 2500 due to illness. It includes personal details such as UAN, PAN, and bank information, certifying the accuracy of the provided information. The application confirms that the bank KYC has been verified online and does not require additional documentation for payment processing.

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saurabhpandit9031
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5 views1 page

Document

The document is an online application for a PF Advance submitted by a member named Satendra on January 5, 2026, for an amount of Rs 2500 due to illness. It includes personal details such as UAN, PAN, and bank information, certifying the accuracy of the provided information. The application confirms that the bank KYC has been verified online and does not require additional documentation for payment processing.

Uploaded by

saurabhpandit9031
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 2026-01-05 08:11:12 (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 - 9289759753
Tracking ID : 10130309804806012
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101303098048
3. Name of the member SATENDRA

4. Date of Joining 09-Oct-2025


5. Permanent Account number / LFkk;h [kkrk la[;k ITSPS9631A

6.a Purpose of Advance Illness

6.b Amount of Advance (In Rs) 2500


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 haldoni greater noida saini wali


gali,noida,GAUTAM BUDDHA
NAGAR,UTTAR PRADESH-201306

Father/Husband/Spouse Name: KALLU MISHRA Date Of Birth: 28-Jan-1984


Bank Account Number 99980124557229 Bank IFSC Code FDRL0000181
Bank Details FEDERAL BANK,NEWDELHI ZONAL OFFICE
Aadhaar 63XXXXXXXX87
Member ID MRNOI33799710000013285
*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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