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The document is a UAN Based Combined Claim Form for PF Advance submitted by Raju Kumar Sharma on March 27, 2025. The purpose of the advance is for illness, with a requested amount of Rs 100,000. The form includes personal details, bank information, and a certification of accuracy for the provided data.

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Raju Kumar Sharma
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10 views2 pages

PDF Download

The document is a UAN Based Combined Claim Form for PF Advance submitted by Raju Kumar Sharma on March 27, 2025. The purpose of the advance is for illness, with a requested amount of Rs 100,000. The form includes personal details, bank information, and a certification of accuracy for the provided data.

Uploaded by

Raju Kumar Sharma
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
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Submitted online at Member e-seva portal on 2025-03-27 07:03:13 (IP www.epfindia.gov.

in
Address:10.70.12.101)

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 - 8210574728
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101645593708
3. Name of the member RAJU KUMAR SHARMA

4. Date of Joining 09-May-2022


5. Permanent Account number / LFkk;h [kkrk la[;k GXTPS8539G

6.a Purpose of Advance Illness

6.b Amount of Advance (In Rs) 100000


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 Block Q No 357 Bhuli


Nagar,Dhanbad,DHANBAD,JHARKHAND-
828104

Father/Husband/Spouse Name: SHIV BALAK SHARMA Date Of Birth: 07-Jul-1998


Bank Account Number 50100380125949 Bank IFSC Code HDFC0003781
Bank Details HDFC BANK,ELECTRONIC CITY PHASE 1 BRANCH
Aadhaar 52XXXXXXXX56
Member ID KDMAL00375280000238614
*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. A cancelled cheque
(containing member's name, bank account number and IFS Code) is attached herewith. 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 .
UAN - 101645593708 Tracking ID - 10164559370806002

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