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{"sheet":"事業所データ","index":0,"n_rows":20,"n_cols":3,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"事業所用データ"]
[null,"※必須項目です"]
[]
[]
[null,"年金　事業所整理記号","51-NX"]
[null,"　　　　例　12-AA（ハイフン入力必須）"]
[null,"年金　事業所番号",130]
[]
[null,"健保　事業所番号",218]
[]
[]
[null,"〒","390-0874"]
[null,"事業所・所在地","松本市長大手３－６－２０"]
[]
[null,"事業所・名称","長野県機械金属健康保険組合"]
[null,"事業主・氏名","理事長　手塚　久仁彦"]
[null,"電話番号　026-123-4567","1234-56-7890"]
[]
[null,"社労士　名称等"]

{"sheet":"被保険者データ","index":1,"n_rows":5009,"n_cols":38,"rows_kept":5009,"cut":false,"hidden":false,"merged":[[3,23,3,24],[4,23,4,24],[5,16,6,20],[7,30,7,32],[7,16,7,20],[6,30,6,32],[5,10,5,11],[6,10,6,11]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩備考欄","1．70歳以上被用者該当"]
[null,"被保険者　データ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,"⑥喪失原因欄　その他",null,null,null,"⑦備考欄"]
[null,"※必須項目です",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"3．短時間労働者の取得（特定適用事業所等）",null,null,null,null,null,null,null,null,null,null,"7. 75歳到達（健康保険のみ喪失）",null,null,null,"1．二以上事業所勤務者の喪失",null,null,"　　転勤により資格喪失する場合は"]
[null,"※保護項目です",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4．退職後の継続再雇用者の取得",null,null,null,null,null,null,"理由欄　(住民票の住所を記載できない理由)",null,null,null,"9. 障害認定（健康保険のみ喪失）",null,null,null,"2．退職後の継続再雇用者の喪失",null,null,"　「3.その他」を○で囲み、（　）内に"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5．その他　（　　　　　　　）",null,null,null,null,null,null,"1．海外在住　2．短期在留　3．その他（　）",null,null,null,"11. 社会保障協定",null,null,null,"3.その他",null,null,"　「○○年○○月○○日転勤」とご記入"]
[null,null,"①年金","①健保","②氏名",null,"③","④性別","⑥個人又は","⑦","⑧",null,"⑨報酬月額",null,null,null,"⑩備考",null,null,null,null,"⑪住所",null,null,null,null,"⑤","⑥喪失原因",null,null,"⑦備考",null,null,null,null,"⑧70歳不該当",null,"退職時健保"]
[null,"連番","整理番号","番号","フリガナ(氏・名　同一セル)","氏名(氏・名　同一セル)","生年月日","(種別)","基礎年金番号","取得年月日","扶養者",null,"㋐通貨","㋑現物","㋒合計","㋓標準報酬",null,null,null,null,null,"〒","フリガナ","住所(住民票の住所)","理由",null,"喪失年月日","4.退職日","5.死亡日","その他","該当番号",null,null,"保険証",null,"70以上不該当","不該当年月日","標準報酬"]
[null,"印 刷",null,null,"全角　氏 と 名 の間１スペース","全角　氏 と 名 の間１スペース","㍼･3　㍻･4","男･1","(文字列)","㋿･5　㍻･4","無･0",null,null,null,null,"自動表示","該当項目(〇の表示)に\"1\"を入力",null,null,null,null,null,null,null,"届出書",null,"㋿･5","㋿･5","㋿･5","該当番号","該当項目(〇の表示)に\"1\"を入力",null,null,"添付枚数","返不能","該当者は","㋿･5","未記入可"]
[null,"番 号",null,null,"アイウエオ　カキュクケコ","阿いうえお　かきゅくけこ",4010101,"女･2","123456789012",5010101,"有･1","人数","円","円","自動計算","千円",1,2,3,4,"5：その他","123-4567",null,null,"の番号",null,5010101,5010101,5010101,"7.9.11",1,2,"3：その他",null,null,"1を入力",5010101,"千円"]
[null,1,12345,54321,"ケンポ　1ロウ","健保　1郎",3500101,1,"123456789012",5010101,0,null,1000000,1000000,{"$f":"M10+N10","v":2000000},{"$f":"VLOOKUP(O10,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":1390},1,null,1,null,"あああああ","123-4567","ナガノケンナガノシオカダマチ７８－１１","長野県長野市岡田町７８－１１",12,null,5040101,5040101,5031231,7.11,1,1,"ああああああ",0,20,1,5050101,58]
[null,2,12346,54320,"ケンポ　2ロウ","健保　2郎",4050101,2,"1234567890",5010102,1,1,1000000,123457,{"$f":"M11+N11","v":1123457},{"$f":"VLOOKUP(O11,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":1150},null,1,null,1,null,"123-4568","ナガノケンナガノシオカダマチ７８－１２","長野県長野市岡田町７８－１２",1,null,5040102,null,5040102,null,1,null,null,1,19,null,5050102,68]
[null,3,12347,54319,"ケンポ　3ロウ","健保　3郎",5010501,1,"123456789014",5010103,0,null,123458,123458,246916,{"$f":"VLOOKUP(O12,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"いいいいい","123-4569","ナガノケンナガノシオカダマチ７８－１３","長野県長野市岡田町７８－１３",2,null,5040103,5040103,null,9,null,1,null,2,18,1,5050103,78]
[null,4,12348,54318,"ケンポ　4ロウ","健保　4郎",3600101,2,"1234567890",5010104,1,2,123459,123459,246918,{"$f":"VLOOKUP(O13,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4570","ナガノケンナガノシオカダマチ７８－１４","長野県長野市岡田町７８－１４",3,null,5040104,null,5040104,null,null,null,"いいいいい",3,17,null,5050104,88]
[null,5,12349,54317,"ケンポ　5ロウ","健保　5郎",3600102,1,"123456789012",5010105,0,null,123460,123460,246920,{"$f":"VLOOKUP(O14,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"あああああ","123-4571","ナガノケンナガノシオカダマチ７８－１５","長野県長野市岡田町７８－１５",12,null,5040105,5040105,null,11,1,1,"ああああああ",4,16,1,5050105,98]
[null,6,12350,54316,"ケンポ　6ロウ","健保　6郎",3600103,2,"1234567891",5010106,1,3,123461,123461,246922,{"$f":"VLOOKUP(O15,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4572","ナガノケンナガノシオカダマチ７８－１６","長野県長野市岡田町７８－１６",13,null,5040106,null,5040106,7.9,1,null,null,5,15,null,5050106,104]
[null,7,12351,54315,"ケンポ　7ロウ","健保　7郎",3600104,1,"123456789014",5010107,0,null,123462,123462,246924,{"$f":"VLOOKUP(O16,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"いいいいい","123-4573","ナガノケンナガノシオカダマチ７８－１７","長野県長野市岡田町７８－１７",123,null,5040107,5040107,null,7.11,null,1,null,6,14,1,5050107,110]
[null,8,12352,54314,"ケンポ　8ロウ","健保　8郎",3600105,2,"1234567891",5010108,1,4,123463,123463,246926,{"$f":"VLOOKUP(O17,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4574","ナガノケンナガノシオカダマチ７８－１８","長野県長野市岡田町７８－１８",null,null,5040108,null,5040108,null,null,null,"いいいいい",1,1,null,5050108,118]
[null,9,12353,54313,"ケンポ　9ロウ","健保　9郎",3600106,1,"123456789012",5010109,0,null,123464,123464,246928,{"$f":"VLOOKUP(O18,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"あああああ","123-4575","ナガノケンナガノシオカダマチ７８－１９","長野県長野市岡田町７８－１９",12,null,5040109,5040109,null,"7.9.11",1,1,"ああああああ",8,12,1,5050109,126]
[null,10,12354,54312,"ケンポ　10ロウ","健保　10郎",3600107,2,"1234567892",5010110,1,5,123465,123465,246930,{"$f":"VLOOKUP(O19,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4576","ナガノケンナガノシオカダマチ７８－２０","長野県長野市岡田町７８－２０",1,null,5040110,null,5040110,7,1,null,null,9,11,null,5050110,134]
[null,11,12355,54311,"ケンポ　11ロウ","健保　11郎",3600108,1,"123456789014",5010111,0,null,123466,123466,246932,{"$f":"VLOOKUP(O20,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"いいいいい","123-4577","ナガノケンナガノシオカダマチ７８－２１","長野県長野市岡田町７８－２１",2,null,5040111,5040111,null,null,null,1,null,10,10,1,5050111,142]
[null,12,12356,54310,"ケンポ　12ロウ","健保　12郎",3600109,2,"1234567892",5010112,1,6,123467,123467,246934,{"$f":"VLOOKUP(O21,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4578","ナガノケンナガノシオカダマチ７８－２２","長野県長野市岡田町７８－２２",3,null,5040112,null,5040112,9,null,null,"いいいいい",11,9,null,5050112,150]
[null,13,12357,54309,"ケンポ　13ロウ","健保　13郎",3600110,1,"123456789012",5010113,0,null,123468,123468,246936,{"$f":"VLOOKUP(O22,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"あああああ","123-4579","ナガノケンナガノシオカダマチ７８－２３","長野県長野市岡田町７８－２３",12,null,5040113,5040113,null,null,1,1,"ああああああ",12,8,1,5050113,160]
[null,14,12358,54308,"ケンポ　14ロウ","健保　14郎",3600111,2,"1234567893",5010114,1,7,123469,123469,246938,{"$f":"VLOOKUP(O23,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4580","ナガノケンナガノシオカダマチ７８－２４","長野県長野市岡田町７８－２４",1,null,5040114,null,5040114,11,1,null,null,13,7,null,5050114,170]
[null,15,12359,54307,"ケンポ　15ロウ","健保　15郎",3600112,1,"123456789014",5010115,0,null,123470,123470,246940,{"$f":"VLOOKUP(O24,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"いいいいい","123-4581","ナガノケンナガノシオカダマチ７８－２５","長野県長野市岡田町７８－２５",2,null,5040115,5040115,null,7.9,null,1,null,14,6,1,5050115,180]
[null,16,12360,54306,"ケンポ　16ロウ","健保　16郎",3600113,2,"1234567893",5010116,1,8,123471,123471,246942,{"$f":"VLOOKUP(O25,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4582","ナガノケンナガノシオカダマチ７８－２６","長野県長野市岡田町７８－２６",3,null,5040116,null,5040116,7.11,null,null,"いいいいい",15,5,null,5050116,190]
[null,17,12361,54305,"ケンポ　17ロウ","健保　17郎",3600114,1,"123456789012",5010117,0,null,123472,123472,246944,{"$f":"VLOOKUP(O26,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"あああああ","123-4583","ナガノケンナガノシオカダマチ７８－２７","長野県長野市岡田町７８－２７",12,null,5040117,5040117,null,9.11,1,1,"ああああああ",16,4,1,5050117,200]
[null,18,12362,54304,"ケンポ　18ロウ","健保　18郎",3600115,2,"1234567894",5010118,1,9,235640,123473,359113,{"$f":"VLOOKUP(O27,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":360},null,1,null,1,null,"123-4584","ナガノケンナガノシオカダマチ７８－２８","長野県長野市岡田町７８－２８",13,null,5040118,null,5040118,"7.9.11",1,null,null,17,3,null,5050118,220]
[null,19,12363,54303,"ケンポ　19ロウ","健保　19郎",3600116,1,"123456789014",5010119,0,null,123474,123474,246948,{"$f":"VLOOKUP(O28,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},1,null,1,null,"いいいいい","123-4585","ナガノケンナガノシオカダマチ７８－２９","長野県長野市岡田町７８－２９",123,null,5040119,5040119,null,null,null,1,null,18,2,1,5050119,240]
[null,20,12364,54302,"ケンポ　20ロウ","健保　20郎",3600117,2,"1234567894",5010120,1,10,123475,123475,246950,{"$f":"VLOOKUP(O29,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":240},null,1,null,1,null,"123-4586","ナガノケンナガノシオカダマチ７８－３０","長野県長野市岡田町７８－３０",null,null,5040120,null,5040120,"7.9.11",null,null,"いいいいい",19,1,null,5050120,260]
[null,21,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"M30+N30","v":0},{"$f":"VLOOKUP(O30,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,22,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O31,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,23,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O32,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,24,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O33,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,25,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O34,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,26,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O35,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,27,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O36,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,28,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O37,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,29,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O38,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,30,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O39,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,31,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O40,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,32,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O41,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,33,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O42,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,34,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O43,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,35,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O44,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,36,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O45,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,37,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O46,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,38,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O47,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,39,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O48,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,40,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O49,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
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[null,1932,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1941,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1933,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1942,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1934,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1943,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1935,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1944,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1936,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1945,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1937,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1946,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1938,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1947,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1939,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1948,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1940,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1949,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1941,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"M1950+N1950","v":0},{"$f":"VLOOKUP(O1950,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1942,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1951,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1943,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1952,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1944,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1953,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1945,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1954,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1946,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1955,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1947,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1956,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1948,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1957,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1949,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1958,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1950,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1959,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1951,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1960,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1952,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1961,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1953,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1962,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1954,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1963,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1955,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1964,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1956,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1965,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1957,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1966,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1958,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1967,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1959,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1968,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1960,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1969,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1961,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1970,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1962,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1971,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1963,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1972,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1964,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1973,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1965,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1974,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1966,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1975,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1967,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1976,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1968,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1977,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1969,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1978,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1970,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1979,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1971,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1980,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1972,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1981,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1973,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1982,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1974,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1983,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1975,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1984,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1976,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1985,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1977,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1986,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1978,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1987,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1979,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1988,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1980,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1989,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1981,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1990,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1982,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1991,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1983,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1992,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1984,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1993,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1985,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1994,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1986,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1995,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1987,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1996,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1988,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1997,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1989,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1998,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1990,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O1999,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1991,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2000,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1992,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2001,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1993,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2002,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1994,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2003,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1995,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2004,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1996,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2005,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1997,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2006,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1998,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2007,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,1999,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2008,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2000,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2009,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2001,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2010,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2002,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2011,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2003,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2012,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2004,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2013,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2005,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"M2014+N2014","v":0},{"$f":"VLOOKUP(O2014,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2006,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2015,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2007,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2016,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2008,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2017,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2009,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2018,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2010,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2019,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2011,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2020,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2012,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2021,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2013,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2022,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2014,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2023,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2015,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2024,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2016,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2025,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2017,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2026,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2018,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2027,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2019,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2028,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2020,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2029,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2021,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2030,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2022,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2031,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2023,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2032,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2024,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2033,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2025,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2034,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2026,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2035,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2027,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2036,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2028,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2037,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2029,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2038,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2030,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2039,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2031,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2040,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2032,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2041,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2033,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2042,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2034,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2043,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2035,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2044,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
[null,2036,null,null,null,null,null,null,null,null,null,null,null,null,0,{"$f":"VLOOKUP(O2045,標準報酬月額リスト!$C$4:$E$100,3,TRUE)","v":58}]
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{"sheet":"印刷用","index":2,"n_rows":53,"n_cols":11,"rows_kept":53,"cut":false,"hidden":false,"merged":[[46,2,47,2],[46,3,47,3],[46,5,47,5],[46,7,47,7],[22,2,23,3],[22,6,23,7],[22,4,23,5],[24,2,24,3],[24,6,24,7]]}
[]
[null,"①出力する届を選択"]
[null,null,null,null,null,null,null,null,null,null,"〇印刷前のプレビュー"]
[null,null,null,null,null,null,null,null,null,null,"　　このシステムには設定できませんでしたが、少し手間がかかりますが"]
[null,null,null,null,null,null,null,null,null,null,"　　「ファイル」「印刷」の　プリンターの中に　【Microsoft PDF】"]
[null,null,null,null,null,null,null,null,null,null,"　　がある場合、そこに作成して画面で見ることが可能です。"]
[null,null,null,null,null,null,null,null,null,null,"　　【作成する場合は、「厚年」の１表のみで良いと思います】"]
[null,"②出力する帳票を選択（複数選択可）"]
[null,null,null,null,null,null,null,null,null,null,"〇年金機構に電子により届出する場合は、厚年のチェックを外してください。"]
[]
[null,null,null,null,null,null,null,null,null,null,"〇手書で届出する場合"]
[null,null,null,null,null,null,null,null,null,null,"　　●健保のみ届出　→　健保(手書用)にて１部提出"]
[null,null,null,null,null,null,null,null,null,null,"　　●健保・年金(組合から回送)両方に届出　→　厚年(手書用)にて２部提出"]
[]
[]
[null,"③データを選択"]
[]
[null,null,null,null,null,null,null,null,null,null,"〇範囲指定は、多人数の取得時に使用してください"]
[]
[null,null,null,null,null,null,null,null,null,null,"〇個別指定は、少人数の取得　及び　喪失時に使用してください"]
[]
[null,null,"範囲指定"]
[null,null,5,null,null,null,8]
[]
[null,null,"から",null,null,null,"まで"]
[null,null,"個別指定"]
[null,null,"頁","被保険者1",2,3,4]
[null,null,1]
[null,null,2]
[null,null,3]
[null,null,4]
[null,null,5]
[null,null,6]
[null,null,7]
[null,null,8]
[null,null,9]
[null,null,10]
[null,null,11]
[null,null,12]
[null,null,13]
[null,null,14]
[null,null,15]
[]
[]
[null,"④提出日を入力"]
[]
[null,null,"令和",4,null,3,null,28]
[null,null,null,null,"年",null,"月",null,"日"]
[]
[]
[null,"⑤印刷実行"]
[null,null,null,null,null,null,null,null,null,null,"〇１届出用紙が複数ページになるときは"]
[null,null,null,null,null,null,null,null,null,null,"　　組合までご連絡をお願いします。"]

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[]
[null,null,"報酬月額",null,"標準報酬"]
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[null,13,155000,165000,160]
[null,14,165000,175000,170]
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[null,17,195000,210000,200]
[null,18,210000,230000,220]
[null,19,230000,250000,240]
[null,20,250000,270000,260]
[null,21,270000,290000,280]
[null,22,290000,310000,300]
[null,23,310000,330000,320]
[null,24,330000,350000,340]
[null,25,350000,370000,360]
[null,26,370000,395000,380]
[null,27,395000,425000,410]
[null,28,425000,455000,440]
[null,29,455000,485000,470]
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[null,31,515000,545000,530]
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[null,36,665000,695000,680]
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[null,39,770000,810000,790]
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[null,41,855000,905000,880]
[null,42,905000,955000,930]
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["a",2,3,4,5,6,7,8,9,10,11,12,13,14,15,null,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"常務理事",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係　　員",null,null,null,null,null,null,null,null,null,null,null,null,"係　　員",null,null,null,null,null,null,null,null,null,null,null,null,131,132,133,134,135,136]
[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,null,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,131,132,133,134,135,136]
[null,2,"健保・取得"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得届"]
[]
[null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
[]
[]
[null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,11]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"届書記入の個人番号に誤りがないことを確認しました。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,"-"]
[null,null,null,null,null,null,"事業所\n所在地"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"事業所\n名　称"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[]
[]
[]
[null,null,null,null,null,null,"事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　氏　　名　　等"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得決定通知書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,117]
[]
[]
[null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
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[null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,11]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"届書記入の個人番号に誤りがないことを確認しました。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,"-"]
[null,null,null,null,null,null,"事業所\n所在地"]
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[]
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[]
[]
[]
[]
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[null,null,null,null,null,null,"事業所\n名　称"]
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[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[]
[]
[]
[null,null,null,null,null,null,"事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　氏　　名　　等"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[]
[null,"　この処分に不服があるときは、処分があったことを知った日の翌日から起算して３か月以内に文書又は口頭で社会保険審査官（地方厚生（支）局内）に対して審査請求をすることができます。また、審査請求の決定に不服があるときは、再審査請求又は処分の取消しの訴えを提起することができます。再審査請求は、審査官の決定書の謄本が送付された日の翌日から起算して２か月以内に文書又は口頭で社会保険審査会（厚生労働省内）に対して行うことができ、処分の取消しの訴えは、審査請求の決定があったことを知った日から６か月以内（再審査請求があったときは、その裁決があったことを知った日から６か月以内）に、健康保険組合を被告として提起することができます。（ただし、原則として、決定又は裁決の日から１年を経過したときは、提起することができなくなります。）\n　なお、審査請求があった日から２か月を経過しても決定がないときや、処分の執行等による著しい損害を避けるため緊急の必要があるとき、その他正当な理由があるときは、審査請求の決定を経なくても提起することができます。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得届にもとづき、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"うえのとおり資格取得の確認および"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬が決定されたので通知します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"長野県機械金属健康保険組合理事長",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]

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[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,null,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,105,106,107,108,109,110,111,112,113,114,116,null,null,118,119,120,121,122,123,125,null,126,127,128,129,130,131,132,133,134,135,136]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険\n厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得届",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,117]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者該当届"]
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[null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
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[null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"届書記入の個人番号に誤りがないことを確認しました。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,"-"]
[null,null,null,null,null,null,"事業所\n所在地"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"事業所\n名　称"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[]
[]
[]
[null,null,null,null,null,null,"事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　氏　　名　　等"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,"協会けんぽご加入の事業所様へ"]
[null,null,null,null,"※　７０歳以上被用者該当届のみ提出の場合は、「⑩備考」欄の「１.７０歳以上被用者該当」"]
[null,null,null,null,"　　および「５.その他」に○をし、「５.その他」の（　）内に「該当届のみ」とご記入ください（この場合、"]
[null,null,null,null,"　　健康保険被保険者証の発行はありません）。"]
[]
[]
[null,"この届書は 「従業員を採用した場合」、「60歳以上の方で退職後に継続して再雇用した場合」 にご提出いただくものです。"]
[]
[null,"・70歳以上の方について提出する場合は、「⑩備考」欄の「1.70歳以上被用者該当」を○で囲んでください。"]
[null,"・次の場合は下記の別様式での届出をお願いします。"]
[null,"　　従業員等が在職中に70歳に到達した場合→『70歳到達届』（資格喪失届・70歳以上被用者該当届）"]
[null,"　　国民健康保険組合に加入する従業員を採用した場合→『被保険者資格取得届（国保組合用）』"]
[]
[null,"記入方法"]
[null,"提出者記入欄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","事業所整理記号・事業所番号は下図を参照し、新規適用時または名称･所在地変更時に付された記号・番号をご記入ください。"]
[null,"　   　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,0,null,1,null,"-",null,"イ",null,"ロ",null,"ハ",null,null,null,"事 業 所\n番　号",null,null,null,null,null,null,1,null,2,null,3,null,4,null,5]
[]
[null,"①被保険者整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","被保険者整理番号を払い出ししますので、記入する必要はありません。"]
[null,"②氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","氏名は住民票に登録されているものと同じ氏名をご記入ください。フリガナはカタカナで正確にご記入ください。"]
[null,"③生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","年号は該当する番号を○で囲んでください。生年月日は下図を参照しご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.昭和\n7.平成\n9.令和",null,null,null,null,null,6,null," 年\n3",null,0,null," 月\n5",null,0,null," 日\n3"]
[null,"　"]
[null,"④種別",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"男子",null,null,null,null,null,"女子",null,null,null,null,null,"坑内員"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"一般（基金未加入）",null,null,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,2,null,null,null,null,null,3]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金基金加入員",null,null,null,null,null,null,null,null,null,null,null,5,null,null,null,null,null,6,null,null,null,null,null,7]
[null,"⑤取得区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　1.健保・厚年",null,null,null,null,null,null,null,null,null,"健康保険・厚生年金保険の被保険者となったとき（船員保険適用者を除く）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3.共済出向",null,null,null,null,null,null,null,null,null,"共済組合から公庫等へ出向した職員であるとき"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4.船保任継",null,null,null,null,null,null,null,null,null,"船員任意継続被保険者であるとき"]
[null,"⑥個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","本人確認を行ったうえで、個人番号をご記入ください。基礎年金番号を記入する場合は、年金手帳等に記載されている10桁の"]
[null,"[基礎年金番号]",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号を左詰めでご記入ください。"]
[null,"⑦取得（該当）年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","適用事業所に使用されるに至った日（事実上の使用関係が発生した日）、（70歳以上被用者該当届としての提出の場合は、70歳"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"以上被用者に該当した日）、その使用される事業所が適用事業所となった日等をご記入ください。"]
[null,"⑧被扶養者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","健康保険の被扶養者がある場合は「1.有」を、ない場合は「0.無」を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「1.有」の場合は『被扶養者（異動）届』の届出が別途必要です。"]
[null,"⑨報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","「㋐（通貨）」は給料・手当等、名称を問わず労働の対償として金銭（通貨）で支払われるすべての合計金額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※1　臨時に支払うものや、3月を超える期間ごとに支払う賞与等は対象となりません。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※2　週給の場合は、報酬額を7で割って得た額の30倍に相当する金額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※3　実績によって報酬が変わる場合は、資格取得月の前月1カ月間に、同事業所内で同様の業務に携わっている従業員の報酬の平均額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「㋑（現物）」は、報酬のうち食事・住宅・被服・定期券等、金銭（通貨）以外で支払われるものについてご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"現物によるものの額は、厚生労働大臣によって定められた額（食事・住宅については都道府県ごとに定められた価額、その他被"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"服等は時価により算定した額）をご記入ください。"]
[null,"⑩備考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","該当する場合に番号を○で囲んでください。"]
[null,"　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「1.70歳以上被用者該当」は、被用者が70歳以上の方の場合に○で囲んでください。"]
[null,"　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在職中に70歳に到達した場合は、この届書ではなく『70歳到達届』（資格喪失届・70歳以上該当届）をご提出ください。"]
[null,"　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「2.二以上事業所勤務者の取得」に該当する場合は、資格取得日から10日以内に、被保険者が『被保険者所属選択・二以上事業"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"所勤務届』を提出する必要があります。"]
[null,"　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「3.短時間労働者の取得（特定適用事業所等）」は、短時間労働者に係る資格取得届を提出する場合に○で囲んでください。"]
[null,"　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「4.退職後の継続再雇用者の取得」に該当する場合は、この届書とあわせて『被保険者資格喪失届』の提出が必要です。"]
[null,"⑪住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","住民票住所をご記入ください。なお、日本国内に住民票（個人番号）を有していない等、住民票住所を記入できない場合は、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居所等を記入のうえ「1.海外在住」　「2.短期在留」　「3.その他」のいずれか該当する理由を○で囲み、「3.その他」に"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"○をした場合は、その理由をご記入ください。※日本年金機構に提出する際「⑥個人番号」欄に個人番号を記入した場合、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所記入は不要です。"]
[null,"添付書類"]
[null,"　・60歳以上の方で退職後の継続再雇用の場合"]
[null,"　　　ア.就業規則・退職辞令のコピー等退職日が確認できる書類、および継続して再雇用されたことが確認できる雇用契約書のコピー"]
[null,"　　　イ.上記「ア」の書類が添付できない場合、事業主の証明書（退職日、再雇用日が記載されているもの）等"]
[null,"お知らせ　"]
[null,"　・マイナンバー制度の導入に伴い、日本年金機構では原則として住民票上の氏名および住所で年金記録を管理することにしています。住民票住所以外"]
[null,"　　の居所等にねんきん定期便等の日本年金機構からの各種お知らせ等の送付をご希望の場合は、別途『住所変更届』をご提出ください。"]
[null,"　・この『被保険者資格取得届・70歳以上被用者該当届』を提出し、資格取得の確認および標準報酬月額が決定されると、『資格取得確認および標準"]
[null,"　　報酬決定通知書』・『70歳以上被用者該当および標準報酬月額相当額のお知らせ』（70歳以上被用者に該当する場合）が事業所に送付されますので、"]
[null,"　　事業主は通知内容を被保険者に通知してください。"]
[null,"  ・「短時間労働者」とは、国・地方公共団体・特定適用事業所等において使用される、以下の全ての要件を満たした場合に被保険者となります。"]
[null,"　　　ア.週の所定労働時間が20時間以上であること。　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,"　　　イ.雇用見込期間が1年以上であること（雇用期間が1年未満であるが、雇用契約書等でその契約が更新される旨または更新される場合がある旨"]
[null," 　　　　明示されている場合を含む）。"]
[null,"　　　ウ.賃金の月額が88,000円（年額106万円相当）以上であること。ただし、①臨時に支払われる賃金（結婚手当等）および1月を超える期間ごと"]
[null," 　　　　に支払われる賃金（賞与等）、②所定時間外労働等に対して支払われる賃金（割増賃金等）、③最低賃金法において算入しないことを定め"]
[null," 　　　　る賃金（精皆勤手当、通勤手当および家族手当）を除く。"]
[null,"　　　エ.学生でないこと。"]
[null," 　　　　※上記ア～エの要件を満たしていても、1週間の所定労働時間および1カ月の所定労働日数が正社員の4分の3以上の従業員については、通常"]
[null,"  　　　 　の被保険者となります。"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"常務理事",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係員",null,null,null,null,null,null,null,null,null,"係員"]
[]
[null,null,null,"健保・喪失"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険",null,null,null,null,null,null,null,null,null,"被保険者資格喪失届"]
[]
[null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
[]
[]
[null,null,"事　業　所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"―",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
[]
[]
[]
[null,null,null,null,null,null,null,"　届書記入の個人番号に誤りがないことを確認しました。"]
[null,null,"事業所\n所在地",null,null,null,null,"〒",null,null,null,null,null,null,null,"-"]
[]
[]
[]
[]
[null,null,"事業所\n名　称"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[null,null,"事業主\n氏　名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名　　等"]
[]
[]
[null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
[]
[]
[]
[]
["　",null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日死亡）",null,null,null,null,null,"9. 障害認定"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有(    人)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,"枚"]
[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
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[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
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[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
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[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
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[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
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[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
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[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
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[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
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[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
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[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
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[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
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[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
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[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
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[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
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[null,null,null,null,null,null,null,"　届書記入の個人番号に誤りがないことを確認しました。"]
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[null,null,"事業主\n氏　名"]
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[]
[]
[null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
[]
["　",null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
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[]
[]
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[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有(    人)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,"枚"]
[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
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[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有(    人)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,"枚"]
[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
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[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有(    人)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,"枚"]
[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
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[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有(    人)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,"枚"]
[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[null,"　この処分に不服があるときは、処分があったことを知った日の翌日から起算して３か月以内に文書又は口頭で社会保険審査官（地方厚生（支）局内）に対して審査請求をすることができます。また、審査請求の決定に不服があるときは、再審査請求又は処分の取消しの訴えを提起することができます。再審査請求は、審査官の決定書の謄本が送付された日の翌日から起算して２か月以内に文書又は口頭で社会保険審査会（厚生労働省内）に対して行うことができ、処分の取消しの訴えは、審査請求の決定があったことを知った日から６か月以内（再審査請求があったときは、その裁決があったことを知った日から６か月以内）に、健康保険組合を被告として提起することができます。（ただし、原則として、決定又は裁決の日から１年を経過したときは、提起することができなくなります。）\n　なお、審査請求があった日から２か月を経過しても決定がないときや、処分の執行等による著しい損害を避けるため緊急の必要があるとき、その他正当な理由があるときは、審査請求の決定を経なくても提起することができます。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格喪失届にもとづき、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"うえのとおり資格喪失が確認され"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"たので通知します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"長野県機械金属健康保険組合理事長",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]

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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険\n厚生年金保険",null,null,null,null,null,null,null,null,null,"被保険者資格喪失届"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者不該当届"]
[]
[null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
[]
[null,null,"事　業　所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"―",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
[]
[]
[]
[null,null,null,null,null,null,null,"　届書記入の個人番号に誤りがないことを確認しました。"]
[null,null,"事業所\n所在地",null,null,null,null,"〒",null,null,null,null,null,null,null,"-"]
[]
[]
[]
[]
[null,null,"事業所\n名　称"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[null,null,"事業主\n氏　名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名　　等"]
[]
[]
[null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
["　",null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当",null,null,null,null,false]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[null,"この届書は、「従業員が退職した場合」、「60歳以上の方で退職後に継続して再雇用した場合」、「従業員が死亡した場"]
[null,"合」、「従業員が75歳に到達した場合」、「障害認定を受け後期高齢者医療の資格を取得した場合」等にご提出いただくも"]
[null,"のです。"]
[null,"・70歳以上の方について提出する場合は、「⑧70歳不該当」欄の「□70歳以上被用者不該当」にチェックを入れてください。"]
[null,"・次の場合は別様式での届出となりますのでご注意ください。"]
[null,"　　従業員等が在職中に70歳に到達した場合→『70歳到達届』（資格喪失届・70歳以上該当届）"]
[]
[null,"記入方法"]
[null,"提出者記入欄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","事業所整理記号・事業所番号は下図を参照し、新規適用時または名称･所在地変更時に付された記号・番号をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事　業　所\n整理記号",null,null,null,null,null,null,null,null,null,null,0,null,1,null,"-",null,"イ",null,"ロ",null,"ハ",null,null,null,"事　業　所\n番　号",null,null,null,null,null,null,1,null,2,null,3,null,4,null,5]
[]
[]
[null,"①被保険者整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","資格取得時に払い出しされた被保険者整理番号を、必ずご記入ください。"]
[null,"②氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","氏名は住民票に登録されているものと同じ氏名をご記入ください。フリガナはカタカナで正確にご記入ください。"]
[null,"③生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","年号は該当する番号を○で囲んでください。生年月日は下図を参照しご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.昭和\n7.平成\n9.令和",null,null,null,null,null,null,"\n6",null,"\n3",null,"\n0",null,"\n5",null,"\n0",null,"\n3"]
[null,null,"　"]
[null,"④個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","本人確認を行ったうえで、個人番号をご記入ください。基礎年金番号を記入する場合は、年金手帳等に記載されている10桁の"]
[null,"（基礎年金番号）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号を左詰めでご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なお、「死亡」による資格喪失の場合は、基礎年金番号をご記入ください。"]
[null,"⑤喪失年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、喪失年月日をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職等による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"退職日の翌日\n転勤の当日\n雇用契約変更の当日"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　死亡による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"死亡日の翌日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　75歳到達による健康保険の資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"誕生日の当日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　障害認定による健康保険の資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認定日の当日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　社会保障協定による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保障協定発効の当日\n相手国法令の適用となった日の翌日"]
[]
[]
[null,"⑥喪失（不該当）原因",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。退職・死亡の場合は、その当日の年月日を（　）内にご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　4.退職等",null,null,null,null,null,null,null,null,null,null,null,"　退職した場合、雇用契約の変更等により被保険者の適用対象外となった場合、退職後に継続して再雇用した場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　5.死亡",null,null,null,null,null,null,null,null,null,null,null,"　死亡した場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　7.75歳到達",null,null,null,null,null,null,null,null,null,null,null,"　75歳に到達したことで後期高齢者医療に該当し、健康保険の被保険者資格を喪失する場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　9.障害認定",null,null,null,null,null,null,null,null,null,null,null,"　65歳以上75歳未満の方で、障害認定により後期高齢者医療に該当し、健康保険の被保険者資格を喪失する場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　11.社会保障協定",null,null,null,null,null,null,null,null,null,null,null,"　社会保障協定により、相手国法令の適用を受け、被保険者資格を喪失する場合"]
[]
[null,"⑦備考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","「1.二以上事業所勤務者の喪失」は、2カ所以上の適用事業所で勤務している被保険者が喪失する場合に○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"60歳以上の者で、退職した者が1日の空白もなく引き続き再雇用された場合、「2.退職後の継続再雇用者の喪失」を○で囲み、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"この届書とあわせて『被保険者資格取得届』をご提出ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"転勤により資格喪失する場合は、「3.その他」を○で囲み、（　）内に「○○年○○月○○日転勤」とご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金基金の加入員である被保険者であって被保険者の資格を取得した月にその資格を喪失した者については、「3.その他」"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"を○で囲み、（　）内に「加入員の資格同月得喪」とご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「保険証回収」欄は、回収した枚数を「添付」、回収できなかった枚数を「返不能」にご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なお、返不能の場合は、『被保険者証回収不能届』をご提出ください。"]
[null,"⑧70歳不該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","70歳以上の方で資格喪失理由が退職、死亡である場合は、「□70歳以上被用者不該当」にチェックを入れてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"また、「不該当年月日」に退職または死亡した当日の年月日をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在職中に70歳に到達された方の厚生年金保険被保険者資格喪失届は、この用紙ではなく『70歳到達届』をご提出ください。"]
[null,"添付書類"]
[null,"　・健康保険被保険者証（本人および被扶養者分）"]
[null,"　　※健康保険被保険者証が回収できない場合は、『被保険者証回収不能届』をご提出ください。"]
[null,"　・60歳以上の方で退職後の継続再雇用の場合"]
[null,"　　　　　ア.就業規則・退職辞令のコピー等退職日が確認できる書類および継続して再雇用されたことが確認できる雇用契約書のコピー"]
[null,"　　　　　イ.上記「ア」の書類が添付できない場合、事業主の証明書（退職日、再雇用日が記載され事業主印が押印されているもの）等"]
[]
[null,"お知らせ　"]
[null,"　・保険料の負担は、資格喪失月の前月分までとなります。退職による資格喪失の場合、喪失日は退職日の翌日となるため、月末に退職した場合は退職月分"]
[null,"　　の保険料まで控除する必要がありますのでご注意ください。"]
[null,"　・退職後の健康保険の任意継続を希望する場合は、全国健康保険協会または各健康保険組合等にお問い合わせください。"]

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["a",2,3,4,5,6,7,8,9,10,11,12,13,14,15,null,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"常務理事",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係　　員",null,null,null,null,null,null,null,null,null,null,null,null,"係　　員",null,null,null,null,null,null,null,null,null,null,null,null,131,132,133,134,135,136]
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[null,2,"健保・取得"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得届"]
[]
[null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
[]
[]
[null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,11]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"届書記入の個人番号に誤りがないことを確認しました。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,"-"]
[null,null,null,null,null,null,"事業所\n所在地"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"事業所\n名　称"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[]
[]
[]
[null,null,null,null,null,null,"事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　氏　　名　　等"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"　1．男　　5．男（基金）\n\n　2．女　　6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―",null,null,null,null,null,null,"(フリガナ)"]

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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得決定通知書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,117]
[]
[]
[null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
[]
[null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,11]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"届書記入の個人番号に誤りがないことを確認しました。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,"-"]
[null,null,null,null,null,null,"事業所\n所在地"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"事業所\n名　称"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[]
[]
[]
[null,null,null,null,null,null,"事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　氏　　名　　等"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"3.昭和\n\n4.平成\n\n5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　1．男　 5．男（基金）\n\n　2．女　 6．女（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n番　　号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"1．健保",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"5.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千",null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[]
[null,"　この処分に不服があるときは、処分があったことを知った日の翌日から起算して３か月以内に文書又は口頭で社会保険審査官（地方厚生（支）局内）に対して審査請求をすることができます。また、審査請求の決定に不服があるときは、再審査請求又は処分の取消しの訴えを提起することができます。再審査請求は、審査官の決定書の謄本が送付された日の翌日から起算して２か月以内に文書又は口頭で社会保険審査会（厚生労働省内）に対して行うことができ、処分の取消しの訴えは、審査請求の決定があったことを知った日から６か月以内（再審査請求があったときは、その裁決があったことを知った日から６か月以内）に、健康保険組合を被告として提起することができます。（ただし、原則として、決定又は裁決の日から１年を経過したときは、提起することができなくなります。）\n　なお、審査請求があった日から２か月を経過しても決定がないときや、処分の執行等による著しい損害を避けるため緊急の必要があるとき、その他正当な理由があるときは、審査請求の決定を経なくても提起することができます。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得届にもとづき、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"うえのとおり資格取得の確認および"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準報酬が決定されたので通知します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"長野県機械金属健康保険組合理事長",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]

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[]
[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,null,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,105,106,107,108,109,110,111,112,113,114,116,null,null,118,119,120,121,122,123,125,null,126,127,128,129,130,131,132,133,134,135,136]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険\n厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得届",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,117]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者該当届"]
[]
[null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
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[null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,11]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"届書記入の個人番号に誤りがないことを確認しました。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,"-"]
[null,null,null,null,null,null,"事業所\n所在地"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"事業所\n名　称"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[]
[]
[]
[null,null,null,null,null,null,"事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　氏　　名　　等"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"⓪．無",null,null,null,null,null,null,null,null,null,"①．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,"協会けんぽご加入の事業所様へ"]
[null,null,null,null,"※　７０歳以上被用者該当届のみ提出の場合は、「⑩備考」欄の「１.７０歳以上被用者該当」"]
[null,null,null,null,"　　および「５.その他」に○をし、「５.その他」の（　）内に「該当届のみ」とご記入ください（この場合、"]
[null,null,null,null,"　　健康保険被保険者証の発行はありません）。"]
[]
[]
[null,"この届書は 「従業員を採用した場合」、「60歳以上の方で退職後に継続して再雇用した場合」 にご提出いただくものです。"]
[]
[null,"・70歳以上の方について提出する場合は、「⑩備考」欄の「1.70歳以上被用者該当」を○で囲んでください。"]
[null,"・次の場合は下記の別様式での届出をお願いします。"]
[null,"　　従業員等が在職中に70歳に到達した場合→『70歳到達届』（資格喪失届・70歳以上被用者該当届）"]
[null,"　　国民健康保険組合に加入する従業員を採用した場合→『被保険者資格取得届（国保組合用）』"]
[]
[null,"記入方法"]
[null,"提出者記入欄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","事業所整理記号・事業所番号は下図を参照し、新規適用時または名称･所在地変更時に付された記号・番号をご記入ください。"]
[null,"　   　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,0,null,1,null,"-",null,"イ",null,"ロ",null,"ハ",null,null,null,"事 業 所\n番　号",null,null,null,null,null,null,1,null,2,null,3,null,4,null,5]
[]
[null,"①被保険者整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","被保険者整理番号を払い出ししますので、記入する必要はありません。"]
[null,"②氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","氏名は住民票に登録されているものと同じ氏名をご記入ください。フリガナはカタカナで正確にご記入ください。"]
[null,"③生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","年号は該当する番号を○で囲んでください。生年月日は下図を参照しご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.昭和\n7.平成\n9.令和",null,null,null,null,null,6,null," 年\n3",null,0,null," 月\n5",null,0,null," 日\n3"]
[null,"　"]
[null,"④種別",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"男子",null,null,null,null,null,"女子",null,null,null,null,null,"坑内員"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"一般（基金未加入）",null,null,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,2,null,null,null,null,null,3]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金基金加入員",null,null,null,null,null,null,null,null,null,null,null,5,null,null,null,null,null,6,null,null,null,null,null,7]
[null,"⑤取得区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　1.健保・厚年",null,null,null,null,null,null,null,null,null,"健康保険・厚生年金保険の被保険者となったとき（船員保険適用者を除く）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3.共済出向",null,null,null,null,null,null,null,null,null,"共済組合から公庫等へ出向した職員であるとき"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4.船保任継",null,null,null,null,null,null,null,null,null,"船員任意継続被保険者であるとき"]
[null,"⑥個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","本人確認を行ったうえで、個人番号をご記入ください。基礎年金番号を記入する場合は、年金手帳等に記載されている10桁の"]
[null,"[基礎年金番号]",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号を左詰めでご記入ください。"]
[null,"⑦取得（該当）年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","適用事業所に使用されるに至った日（事実上の使用関係が発生した日）、（70歳以上被用者該当届としての提出の場合は、70歳"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"以上被用者に該当した日）、その使用される事業所が適用事業所となった日等をご記入ください。"]
[null,"⑧被扶養者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","健康保険の被扶養者がある場合は「1.有」を、ない場合は「0.無」を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「1.有」の場合は『被扶養者（異動）届』の届出が別途必要です。"]
[null,"⑨報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","「㋐（通貨）」は給料・手当等、名称を問わず労働の対償として金銭（通貨）で支払われるすべての合計金額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※1　臨時に支払うものや、3月を超える期間ごとに支払う賞与等は対象となりません。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※2　週給の場合は、報酬額を7で割って得た額の30倍に相当する金額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※3　実績によって報酬が変わる場合は、資格取得月の前月1カ月間に、同事業所内で同様の業務に携わっている従業員の報酬の平均額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「㋑（現物）」は、報酬のうち食事・住宅・被服・定期券等、金銭（通貨）以外で支払われるものについてご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"現物によるものの額は、厚生労働大臣によって定められた額（食事・住宅については都道府県ごとに定められた価額、その他被"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"服等は時価により算定した額）をご記入ください。"]
[null,"⑩備考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","該当する場合に番号を○で囲んでください。"]
[null,"　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「1.70歳以上被用者該当」は、被用者が70歳以上の方の場合に○で囲んでください。"]
[null,"　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在職中に70歳に到達した場合は、この届書ではなく『70歳到達届』（資格喪失届・70歳以上該当届）をご提出ください。"]
[null,"　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「2.二以上事業所勤務者の取得」に該当する場合は、資格取得日から10日以内に、被保険者が『被保険者所属選択・二以上事業"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"所勤務届』を提出する必要があります。"]
[null,"　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「3.短時間労働者の取得（特定適用事業所等）」は、短時間労働者に係る資格取得届を提出する場合に○で囲んでください。"]
[null,"　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「4.退職後の継続再雇用者の取得」に該当する場合は、この届書とあわせて『被保険者資格喪失届』の提出が必要です。"]
[null,"⑪住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","住民票住所をご記入ください。なお、日本国内に住民票（個人番号）を有していない等、住民票住所を記入できない場合は、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居所等を記入のうえ「1.海外在住」　「2.短期在留」　「3.その他」のいずれか該当する理由を○で囲み、「3.その他」に"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"○をした場合は、その理由をご記入ください。※日本年金機構に提出する際「⑥個人番号」欄に個人番号を記入した場合、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所記入は不要です。"]
[null,"添付書類"]
[null,"　・60歳以上の方で退職後の継続再雇用の場合"]
[null,"　　　ア.就業規則・退職辞令のコピー等退職日が確認できる書類、および継続して再雇用されたことが確認できる雇用契約書のコピー"]
[null,"　　　イ.上記「ア」の書類が添付できない場合、事業主の証明書（退職日、再雇用日が記載されているもの）等"]
[null,"お知らせ　"]
[null,"　・マイナンバー制度の導入に伴い、日本年金機構では原則として住民票上の氏名および住所で年金記録を管理することにしています。住民票住所以外"]
[null,"　　の居所等にねんきん定期便等の日本年金機構からの各種お知らせ等の送付をご希望の場合は、別途『住所変更届』をご提出ください。"]
[null,"　・この『被保険者資格取得届・70歳以上被用者該当届』を提出し、資格取得の確認および標準報酬月額が決定されると、『資格取得確認および標準"]
[null,"　　報酬決定通知書』・『70歳以上被用者該当および標準報酬月額相当額のお知らせ』（70歳以上被用者に該当する場合）が事業所に送付されますので、"]
[null,"　　事業主は通知内容を被保険者に通知してください。"]
[null,"  ・「短時間労働者」とは、国・地方公共団体・特定適用事業所等において使用される、以下の全ての要件を満たした場合に被保険者となります。"]
[null,"　　　ア.週の所定労働時間が20時間以上であること。　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,"　　　イ.雇用見込期間が1年以上であること（雇用期間が1年未満であるが、雇用契約書等でその契約が更新される旨または更新される場合がある旨"]
[null," 　　　　明示されている場合を含む）。"]
[null,"　　　ウ.賃金の月額が88,000円（年額106万円相当）以上であること。ただし、①臨時に支払われる賃金（結婚手当等）および1月を超える期間ごと"]
[null," 　　　　に支払われる賃金（賞与等）、②所定時間外労働等に対して支払われる賃金（割増賃金等）、③最低賃金法において算入しないことを定め"]
[null," 　　　　る賃金（精皆勤手当、通勤手当および家族手当）を除く。"]
[null,"　　　エ.学生でないこと。"]
[null," 　　　　※上記ア～エの要件を満たしていても、1週間の所定労働時間および1カ月の所定労働日数が正社員の4分の3以上の従業員については、通常"]
[null,"  　　　 　の被保険者となります。"]

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[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険\n厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格取得届",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,117]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者該当届"]
[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,11]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"届書記入の個人番号に誤りがないことを確認しました。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,"-"]
[null,null,null,null,null,null,"事業所\n所在地"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"事業所\n名　称"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[]
[]
[]
[null,null,null,null,null,null,"事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　氏　　名　　等"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,"5.昭和\n\n7.平成\n\n9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④",null,null,null,null,null,"　　1．男　　　　　　5．男（基金）\n　　2．女　　　　　　6．女（基金）\n　　3．坑内員　　　7．坑内員\n　　　　　　　　　　　　　　　（基金）"]
[]
[null,null,null,null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"種  別"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"⑤",null,null,null,null,null,null,"　1．健保・厚年",null,null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,"9.令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,"0．無",null,null,null,null,null,null,null,null,null,"1．有"]
[]
[null,null,null,null,null,null,"取　得\n区　分",null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取得\n（該当）\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"3．共済出向　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基礎年\n金番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"4．船保任継"]
[]
[]
[null,null,null,null,null,null,"⑨",null,null,null,null,null,null,"㋐（通貨）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋒（合計　㋐+㋑）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩",null,null,null,null,null,null,null,"該当する項目を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．短時間労働者の取得（特定適用事業所等）"]
[null,null,null,null,null,null,null,"報  酬\n月  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備  考"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　1．70歳以上被用者該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4．退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"㋑（現物）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,"　　　2．二以上事業所勤務者の取得",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5．その他　（　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,"⑪",null,null,null,null,null,null,"日本年金機構に提出する際、個人番号を記入した場合は、住所記入は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由：",null,null,null,"　1．海外在住\n　2．短期在留\n　3．その他（　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,"住　所",null,null,null,null,null,null,"〒",null,null,null,null,null,"―"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,"協会けんぽご加入の事業所様へ"]
[null,null,null,null,"※　７０歳以上被用者該当届のみ提出の場合は、「⑩備考」欄の「１.７０歳以上被用者該当」"]
[null,null,null,null,"　　および「５.その他」に○をし、「５.その他」の（　）内に「該当届のみ」とご記入ください（この場合、"]
[null,null,null,null,"　　健康保険被保険者証の発行はありません）。"]
[]
[]
[null,"この届書は 「従業員を採用した場合」、「60歳以上の方で退職後に継続して再雇用した場合」 にご提出いただくものです。"]
[]
[null,"・70歳以上の方について提出する場合は、「⑩備考」欄の「1.70歳以上被用者該当」を○で囲んでください。"]
[null,"・次の場合は下記の別様式での届出をお願いします。"]
[null,"　　従業員等が在職中に70歳に到達した場合→『70歳到達届』（資格喪失届・70歳以上被用者該当届）"]
[null,"　　国民健康保険組合に加入する従業員を採用した場合→『被保険者資格取得届（国保組合用）』"]
[]
[null,"記入方法"]
[null,"提出者記入欄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","事業所整理記号・事業所番号は下図を参照し、新規適用時または名称･所在地変更時に付された記号・番号をご記入ください。"]
[null,"　   　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事 業 所\n整理記号",null,null,null,null,null,null,null,null,null,null,0,null,1,null,"-",null,"イ",null,"ロ",null,"ハ",null,null,null,"事 業 所\n番　号",null,null,null,null,null,null,1,null,2,null,3,null,4,null,5]
[]
[null,"①被保険者整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","被保険者整理番号を払い出ししますので、記入する必要はありません。"]
[null,"②氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","氏名は住民票に登録されているものと同じ氏名をご記入ください。フリガナはカタカナで正確にご記入ください。"]
[null,"③生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","年号は該当する番号を○で囲んでください。生年月日は下図を参照しご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.昭和\n7.平成\n9.令和",null,null,null,null,null,6,null," 年\n3",null,0,null," 月\n5",null,0,null," 日\n3"]
[null,"　"]
[null,"④種別",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"男子",null,null,null,null,null,"女子",null,null,null,null,null,"坑内員"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"一般（基金未加入）",null,null,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,2,null,null,null,null,null,3]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金基金加入員",null,null,null,null,null,null,null,null,null,null,null,5,null,null,null,null,null,6,null,null,null,null,null,7]
[null,"⑤取得区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　1.健保・厚年",null,null,null,null,null,null,null,null,null,"健康保険・厚生年金保険の被保険者となったとき（船員保険適用者を除く）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3.共済出向",null,null,null,null,null,null,null,null,null,"共済組合から公庫等へ出向した職員であるとき"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4.船保任継",null,null,null,null,null,null,null,null,null,"船員任意継続被保険者であるとき"]
[null,"⑥個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","本人確認を行ったうえで、個人番号をご記入ください。基礎年金番号を記入する場合は、年金手帳等に記載されている10桁の"]
[null,"[基礎年金番号]",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号を左詰めでご記入ください。"]
[null,"⑦取得（該当）年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","適用事業所に使用されるに至った日（事実上の使用関係が発生した日）、（70歳以上被用者該当届としての提出の場合は、70歳"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"以上被用者に該当した日）、その使用される事業所が適用事業所となった日等をご記入ください。"]
[null,"⑧被扶養者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","健康保険の被扶養者がある場合は「1.有」を、ない場合は「0.無」を○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「1.有」の場合は『被扶養者（異動）届』の届出が別途必要です。"]
[null,"⑨報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","「㋐（通貨）」は給料・手当等、名称を問わず労働の対償として金銭（通貨）で支払われるすべての合計金額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※1　臨時に支払うものや、3月を超える期間ごとに支払う賞与等は対象となりません。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※2　週給の場合は、報酬額を7で割って得た額の30倍に相当する金額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※3　実績によって報酬が変わる場合は、資格取得月の前月1カ月間に、同事業所内で同様の業務に携わっている従業員の報酬の平均額をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「㋑（現物）」は、報酬のうち食事・住宅・被服・定期券等、金銭（通貨）以外で支払われるものについてご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"現物によるものの額は、厚生労働大臣によって定められた額（食事・住宅については都道府県ごとに定められた価額、その他被"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"服等は時価により算定した額）をご記入ください。"]
[null,"⑩備考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","該当する場合に番号を○で囲んでください。"]
[null,"　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「1.70歳以上被用者該当」は、被用者が70歳以上の方の場合に○で囲んでください。"]
[null,"　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在職中に70歳に到達した場合は、この届書ではなく『70歳到達届』（資格喪失届・70歳以上該当届）をご提出ください。"]
[null,"　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「2.二以上事業所勤務者の取得」に該当する場合は、資格取得日から10日以内に、被保険者が『被保険者所属選択・二以上事業"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"所勤務届』を提出する必要があります。"]
[null,"　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「3.短時間労働者の取得（特定適用事業所等）」は、短時間労働者に係る資格取得届を提出する場合に○で囲んでください。"]
[null,"　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「4.退職後の継続再雇用者の取得」に該当する場合は、この届書とあわせて『被保険者資格喪失届』の提出が必要です。"]
[null,"⑪住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","住民票住所をご記入ください。なお、日本国内に住民票（個人番号）を有していない等、住民票住所を記入できない場合は、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居所等を記入のうえ「1.海外在住」　「2.短期在留」　「3.その他」のいずれか該当する理由を○で囲み、「3.その他」に"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"○をした場合は、その理由をご記入ください。※日本年金機構に提出する際「⑥個人番号」欄に個人番号を記入した場合、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所記入は不要です。"]
[null,"添付書類"]
[null,"　・60歳以上の方で退職後の継続再雇用の場合"]
[null,"　　　ア.就業規則・退職辞令のコピー等退職日が確認できる書類、および継続して再雇用されたことが確認できる雇用契約書のコピー"]
[null,"　　　イ.上記「ア」の書類が添付できない場合、事業主の証明書（退職日、再雇用日が記載されているもの）等"]
[null,"お知らせ　"]
[null,"　・マイナンバー制度の導入に伴い、日本年金機構では原則として住民票上の氏名および住所で年金記録を管理することにしています。住民票住所以外"]
[null,"　　の居所等にねんきん定期便等の日本年金機構からの各種お知らせ等の送付をご希望の場合は、別途『住所変更届』をご提出ください。"]
[null,"　・この『被保険者資格取得届・70歳以上被用者該当届』を提出し、資格取得の確認および標準報酬月額が決定されると、『資格取得確認および標準"]
[null,"　　報酬決定通知書』・『70歳以上被用者該当および標準報酬月額相当額のお知らせ』（70歳以上被用者に該当する場合）が事業所に送付されますので、"]
[null,"　　事業主は通知内容を被保険者に通知してください。"]
[null,"  ・「短時間労働者」とは、国・地方公共団体・特定適用事業所等において使用される、以下の全ての要件を満たした場合に被保険者となります。"]
[null,"　　　ア.週の所定労働時間が20時間以上であること。　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,"　　　イ.雇用見込期間が1年以上であること（雇用期間が1年未満であるが、雇用契約書等でその契約が更新される旨または更新される場合がある旨"]
[null," 　　　　明示されている場合を含む）。"]
[null,"　　　ウ.賃金の月額が88,000円（年額106万円相当）以上であること。ただし、①臨時に支払われる賃金（結婚手当等）および1月を超える期間ごと"]
[null," 　　　　に支払われる賃金（賞与等）、②所定時間外労働等に対して支払われる賃金（割増賃金等）、③最低賃金法において算入しないことを定め"]
[null," 　　　　る賃金（精皆勤手当、通勤手当および家族手当）を除く。"]
[null,"　　　エ.学生でないこと。"]
[null," 　　　　※上記ア～エの要件を満たしていても、1週間の所定労働時間および1カ月の所定労働日数が正社員の4分の3以上の従業員については、通常"]
[null,"  　　　 　の被保険者となります。"]

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140,55,144,57],[140,58,144,60],[140,61,144,66],[140,3,141,4],[140,8,141,9],[140,10,149,12],[140,13,149,15],[140,16,149,18],[140,67,144,82]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"常務理事",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係員",null,null,null,null,null,null,null,null,null,"係員"]
[]
[null,null,null,"健保・喪失"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険",null,null,null,null,null,null,null,null,null,"被保険者資格喪失届"]
[]
[null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
[]
[]
[null,null,"事　業　所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"―",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
[]
[]
[]
[null,null,null,null,null,null,null,"　届書記入の個人番号に誤りがないことを確認しました。"]
[null,null,"事業所\n所在地",null,null,null,null,"〒",null,null,null,null,null,null,null,"-"]
[]
[]
[]
[]
[null,null,"事業所\n名　称"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[null,null,"事業主\n氏　名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名　　等"]
[]
[]
[null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
[]
[]
[]
[]
["　",null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日死亡）",null,null,null,null,null,"9. 障害認定"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[]
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[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
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[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[]
[]
[]
[]
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[]
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[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
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[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
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[]
[]
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[]
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[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
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[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[]
[]
[]
[]
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[]
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[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
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[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
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[]
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[]
[]
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[]
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[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
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[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
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[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
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[]
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[]
[]
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[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
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[null,null,null,null,null,null,null,"　届書記入の個人番号に誤りがないことを確認しました。"]
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[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
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[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
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[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
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[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日死亡）",null,null,null,null,null,"9. 障害認定"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有(    人)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,"枚"]
[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"1．男\n2．女",null,null,null,null,null,"③",null,null,null,null,"3．昭和\n\n4．平成\n\n5．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n性　別",null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"\n氏　　名"]
[]
[]
[]
[null,null,null,"⑤",null,null,null,null,"5.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日退職等）",null,null,null,null,null,"7. 75歳到達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑩"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,"喪　失\n年月日",null,null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標　準\n報　酬"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,null,"（令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日死亡）",null,null,null,null,null,"9. 障害認定"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"無",null,null,null,null,null,null,null,null,null,"証回収",null,null,null,null,"添付",null,null,null,null,null,null,null,null,"枚"]
[]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　3．その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被　扶\n養　者"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有(    人)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,"枚"]
[null,null,null,null,null,null,null,null,"2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[null,"　この処分に不服があるときは、処分があったことを知った日の翌日から起算して３か月以内に文書又は口頭で社会保険審査官（地方厚生（支）局内）に対して審査請求をすることができます。また、審査請求の決定に不服があるときは、再審査請求又は処分の取消しの訴えを提起することができます。再審査請求は、審査官の決定書の謄本が送付された日の翌日から起算して２か月以内に文書又は口頭で社会保険審査会（厚生労働省内）に対して行うことができ、処分の取消しの訴えは、審査請求の決定があったことを知った日から６か月以内（再審査請求があったときは、その裁決があったことを知った日から６か月以内）に、健康保険組合を被告として提起することができます。（ただし、原則として、決定又は裁決の日から１年を経過したときは、提起することができなくなります。）\n　なお、審査請求があった日から２か月を経過しても決定がないときや、処分の執行等による著しい損害を避けるため緊急の必要があるとき、その他正当な理由があるときは、審査請求の決定を経なくても提起することができます。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格喪失届にもとづき、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"うえのとおり資格喪失が確認され"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"たので通知します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"長野県機械金属健康保険組合理事長",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]

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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健　康　保　険\n厚生年金保険",null,null,null,null,null,null,null,null,null,"被保険者資格喪失届"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者不該当届"]
[]
[null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日提出"]
[]
[null,null,"事　業　所\n整理記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"―",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所\n番　号"]
[]
[]
[]
[null,null,null,null,null,null,null,"　届書記入の個人番号に誤りがないことを確認しました。"]
[null,null,"事業所\n所在地",null,null,null,null,"〒",null,null,null,null,null,null,null,"-"]
[]
[]
[]
[]
[null,null,"事業所\n名　称"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄"]
[null,null,"事業主\n氏　名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名　　等"]
[]
[]
[null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
["　",null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当",null,null,null,null,false]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[null,null,null,"①",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,"5．昭和\n\n7．平成\n\n9．令和"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n生　年\n月　日"]
[null,null,null,"被保険者\n整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,"9.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　4. 退職等",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日退職等）"]
[null,null,null,"個 人\n番 号\n\n基礎年\n金番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n喪　失\n（不該当）\n原　因"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"喪　失\n年月日",null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　5. 死亡",null,null,null,null,null,"（令和　",null,null,null,null,"年",null,null,null,"月",null,null,null,"日死亡）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　7. 75歳到達（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　9. 障害認定（健康保険のみ喪失）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　11. 社会保障協定"]
[]
[null,null,null,"⑦",null,null,null,null,"　該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証回収",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,"　 70歳以上被用者不該当\n　 （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,null,"\n備考",null,null,null,null,"1．二以上事業所勤務者の喪失　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3．その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,"不該当年月日",null,null,null,null,null,null,null,null," 9.\n 令和"]
[null,null,null,null,null,null,null,null,"　2．退職後の継続再雇用者の喪失"]
[]
[]
[]
[]
[null,"この届書は、「従業員が退職した場合」、「60歳以上の方で退職後に継続して再雇用した場合」、「従業員が死亡した場"]
[null,"合」、「従業員が75歳に到達した場合」、「障害認定を受け後期高齢者医療の資格を取得した場合」等にご提出いただくも"]
[null,"のです。"]
[null,"・70歳以上の方について提出する場合は、「⑧70歳不該当」欄の「□70歳以上被用者不該当」にチェックを入れてください。"]
[null,"・次の場合は別様式での届出となりますのでご注意ください。"]
[null,"　　従業員等が在職中に70歳に到達した場合→『70歳到達届』（資格喪失届・70歳以上該当届）"]
[]
[null,"記入方法"]
[null,"提出者記入欄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","事業所整理記号・事業所番号は下図を参照し、新規適用時または名称･所在地変更時に付された記号・番号をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事　業　所\n整理記号",null,null,null,null,null,null,null,null,null,null,0,null,1,null,"-",null,"イ",null,"ロ",null,"ハ",null,null,null,"事　業　所\n番　号",null,null,null,null,null,null,1,null,2,null,3,null,4,null,5]
[]
[]
[null,"①被保険者整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","資格取得時に払い出しされた被保険者整理番号を、必ずご記入ください。"]
[null,"②氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","氏名は住民票に登録されているものと同じ氏名をご記入ください。フリガナはカタカナで正確にご記入ください。"]
[null,"③生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","年号は該当する番号を○で囲んでください。生年月日は下図を参照しご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.昭和\n7.平成\n9.令和",null,null,null,null,null,null,"\n6",null,"\n3",null,"\n0",null,"\n5",null,"\n0",null,"\n3"]
[null,null,"　"]
[null,"④個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","本人確認を行ったうえで、個人番号をご記入ください。基礎年金番号を記入する場合は、年金手帳等に記載されている10桁の"]
[null,"（基礎年金番号）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号を左詰めでご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なお、「死亡」による資格喪失の場合は、基礎年金番号をご記入ください。"]
[null,"⑤喪失年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、喪失年月日をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職等による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"退職日の翌日\n転勤の当日\n雇用契約変更の当日"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　死亡による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"死亡日の翌日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　75歳到達による健康保険の資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"誕生日の当日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　障害認定による健康保険の資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認定日の当日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　社会保障協定による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保障協定発効の当日\n相手国法令の適用となった日の翌日"]
[]
[]
[null,"⑥喪失（不該当）原因",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。退職・死亡の場合は、その当日の年月日を（　）内にご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　4.退職等",null,null,null,null,null,null,null,null,null,null,null,"　退職した場合、雇用契約の変更等により被保険者の適用対象外となった場合、退職後に継続して再雇用した場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　5.死亡",null,null,null,null,null,null,null,null,null,null,null,"　死亡した場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　7.75歳到達",null,null,null,null,null,null,null,null,null,null,null,"　75歳に到達したことで後期高齢者医療に該当し、健康保険の被保険者資格を喪失する場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　9.障害認定",null,null,null,null,null,null,null,null,null,null,null,"　65歳以上75歳未満の方で、障害認定により後期高齢者医療に該当し、健康保険の被保険者資格を喪失する場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　11.社会保障協定",null,null,null,null,null,null,null,null,null,null,null,"　社会保障協定により、相手国法令の適用を受け、被保険者資格を喪失する場合"]
[]
[null,"⑦備考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","「1.二以上事業所勤務者の喪失」は、2カ所以上の適用事業所で勤務している被保険者が喪失する場合に○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"60歳以上の者で、退職した者が1日の空白もなく引き続き再雇用された場合、「2.退職後の継続再雇用者の喪失」を○で囲み、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"この届書とあわせて『被保険者資格取得届』をご提出ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"転勤により資格喪失する場合は、「3.その他」を○で囲み、（　）内に「○○年○○月○○日転勤」とご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金基金の加入員である被保険者であって被保険者の資格を取得した月にその資格を喪失した者については、「3.その他」"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"を○で囲み、（　）内に「加入員の資格同月得喪」とご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「保険証回収」欄は、回収した枚数を「添付」、回収できなかった枚数を「返不能」にご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なお、返不能の場合は、『被保険者証回収不能届』をご提出ください。"]
[null,"⑧70歳不該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","70歳以上の方で資格喪失理由が退職、死亡である場合は、「□70歳以上被用者不該当」にチェックを入れてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"また、「不該当年月日」に退職または死亡した当日の年月日をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在職中に70歳に到達された方の厚生年金保険被保険者資格喪失届は、この用紙ではなく『70歳到達届』をご提出ください。"]
[null,"添付書類"]
[null,"　・健康保険被保険者証（本人および被扶養者分）"]
[null,"　　※健康保険被保険者証が回収できない場合は、『被保険者証回収不能届』をご提出ください。"]
[null,"　・60歳以上の方で退職後の継続再雇用の場合"]
[null,"　　　　　ア.就業規則・退職辞令のコピー等退職日が確認できる書類および継続して再雇用されたことが確認できる雇用契約書のコピー"]
[null,"　　　　　イ.上記「ア」の書類が添付できない場合、事業主の証明書（退職日、再雇用日が記載され事業主印が押印されているもの）等"]
[]
[null,"お知らせ　"]
[null,"　・保険料の負担は、資格喪失月の前月分までとなります。退職による資格喪失の場合、喪失日は退職日の翌日となるため、月末に退職した場合は退職月分"]
[null,"　　の保険料まで控除する必要がありますのでご注意ください。"]
[null,"　・退職後の健康保険の任意継続を希望する場合は、全国健康保険協会または各健康保険組合等にお問い合わせください。"]