Submitted online at UAN e-seva portal on 2020-12-30 12:25:25 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 - 9866267653
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101557399107
3. Name of the member UPPARI CHINNA MAHESWARI
4. Date of Joining 23-Jan-2020
5. Permanent Account number / LFkk;h [kkrk la[;k N.A.

6.a Purpose of Advance OUTBREAK OF PANDEMIC (COVID-19)

6.b Amount of Advance (In Rs) 7000

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 chaitanya enclave ,watchmenroom, ground

floor
khajaguda,hyderabad,HYDERABAD,TELANG

* 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: NARAYANA Date Of Birth: 25-Aug-1982
Bank Account Number 919866267653 Bank IFSC Code PYTM0123456
Bank Details PAYTM PAYMENTS BANK LTD,NOIDA BRANCH
Aadhaar 86XXXXXXXX24
Member ID APHYD00261250000027768
* —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 - 101557399107 Tracking ID - 10155739910706001