Submitted online at Member e-seva portal on 2025-08-19 20:02:44 (IP www.epfindia.gov.
in
Address:10.70.13.115)
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 - 7715917516
Tracking ID : 10172658970006003
1. I want to apply for PF Advance
2. Universal Account Number(UAN) / ;wfuolZy [kkrk la[;k 101726589700
3. Name of the member LALITA SURESH VAIRALKAR
4. Date of Joining 15-Sep-2023
5. Permanent Account number / LFkk;h [kkrk la[;k ARGPV9430J
6.a Purpose of Advance Illness
6.b Amount of Advance (In Rs) 40000
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 Flat 403 House no 226/227 Krishna Niwas
Sarsole Sector 6 Nerul,NAVI
MUMBAI,THANE,MAHARASHTRA-400706
Father/Husband/Spouse Name: SURESH Date Of Birth: 16-Apr-1972
Bank Account Number 6203000100007142 Bank IFSC Code PUNB0718300
Bank Details PUNJAB NATIONAL BANK,NAVI MUMBAI, NERUL
Aadhaar 34XXXXXXXX00
Member ID THVSH16767830000018045
*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.
