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    The document is a form submitted online for an Employees' Provident Fund (EPF) advance. It provides details of the applicant such as name, UAN number, bank account and Aadhaar details. The applicant is requesting an advance of Rs. 3000 for non-receipt of wages exceeding 2 months.

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    The document is a form submitted online for an Employees' Provident Fund (EPF) advance. It provides details of the applicant such as name, UAN number, bank account and Aadhaar details. The applicant is requesting an advance of Rs. 3000 for non-receipt of wages exceeding 2 months.

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    The document is a form submitted online for an Employees' Provident Fund (EPF) advance. It provides details of the applicant such as name, UAN number, bank account and Aadhaar details. The applicant is requesting an advance of Rs. 3000 for non-receipt of wages exceeding 2 months.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    6 views3 pages

    PDF Download

    Uploaded by

    jatin
    The document is a form submitted online for an Employees' Provident Fund (EPF) advance. It provides details of the applicant such as name, UAN number, bank account and Aadhaar details. The applicant is requesting an advance of Rs. 3000 for non-receipt of wages exceeding 2 months.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 3

    Submitted online at UAN e-seva portal on 2024-04-01 23:23:25 (IP Address:117.98.4.68) 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 - 9625324664
    1. I want to apply for PF Advance
    2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101276095794
    3. Name of the member JATIN DESWAL

    4. Date of Joining 05-Aug-2023


    5. Permanent Account number / LFkk;h [kkrk la[;k EYVPD1978M

    6.a Purpose of Advance Non Receipt of Wages (>2 months)

    6.b Amount of Advance (In Rs) 3000


    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 E78 dabua colony Air force


    road,Faridabad,FARIDABAD,HARYANA-
    121001

    Father/Husband/Spouse Name: SATISH DESWAL Date Of Birth: 25-Nov-1997


    Bank Account Number 3721326284 Bank IFSC Code CBIN0283242
    Bank Details CENTRAL BANK OF INDIA,DP SCHOOL FARIDABAD
    Aadhaar 82XXXXXXXX23
    Member ID HRFBD00108390000070651
    *Certified that the particulars are true to the best of my knowledge, 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 Aadhaar number to
    be correct. Please make the payment in the bank account mentioned in the UAN 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 UAN portal .
    UAN - 101276095794 Tracking ID - 10127609579406005

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