Submitted online at UAN e-seva portal on 2021-08-20 20:52:05
www.epfindia.gov.in
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 UAN Portal and UAN has been activated.)
Mobile Number / eksckby uacj 9729753820
1.
I want to apply for
PF Advance
2.
Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k
3.
Name of the member
4.
Date of Joining
5.
Permanent Account number / LFkk;h [kkrk la[;k
CYIPS9983A
6.a
Purpose of Advance
Illness
6.b
Amount of Advance (In Rs)
100106557771
BALDEV SINGH
01-Mar-2017
4993
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
third party)
Not Applicable
9.
Payee Address
56, Rajiv Garden Bank Colony,
Yamunanagar,Yamunanagar,YAMUNANAG
AR,HARYANA-135001
* eSa çekf.kr djrk gw¡ fd eSaus ;w , ,u iksVZy ij lhM MkVk dks Hkyh Hkk¡fr ns[k fy;k gS rFkk QkeZ u- 11( u;k ) cSad [kkrk fooj.k vkSj vk/kkj
la[;k lfgr lHkh MkVk lgh ik;k x;k gSA
* I certify that I have gone through the data seeded in UAN Portal and found all data including Form No.11
(New) , bank account details and Aadhar Number to be correct
Father/Husband/Spouse Name: LAL SINGH
Date Of Birth: 16-Aug-1975
Bank Account Number
20281165382
Bank IFSC Code
SBIN0001293
Bank Details
STATE BANK OF INDIA,YAMUNANAGAR
Aadhaar
39XXXXXXXX18
Member ID
HRKNL15630450000010021
* —i;k ;w-,-,u-iksVZy ij n'kkZ, x, cSad [kkrs esa Hkqxrku djsaA
* Please make payment in the bank account mentioned in the UAN portal .
UAN -
100106557771
Tracking ID -
10010655777106009