{"text_format":"1","workbook":"xlsx","n_sheets":1,"sheets":["任継・再雇用用 "],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":1,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"任継・再雇用用 ","index":0,"n_rows":75,"n_cols":54,"rows_kept":75,"cut":false,"hidden":false,"merged":[[36,16,36,22],[36,28,36,34],[41,17,41,28],[50,34,50,38],[51,34,51,38],[52,34,52,38],[56,35,56,38],[57,35,57,38],[52,19,52,27],[56,20,56,21],[56,22,56,23],[56,24,56,34],[74,3,74,40],[59,28,59,29],[59,31,59,32],[60,14,60,18],[60,20,60,21],[60,22,60,23],[69,0,70,4],[71,0,72,4],[58,35,58,38],[59,35,59,38],[60,35,60,38],[59,17,59,23],[71,33,73,34],[71,29,73,32],[71,5,72,23],[69,5,70,23],[60,24,60,34],[69,29,70,34],[65,4,65,11],[66,7,66,14],[66,21,66,31],[67,2,67,34],[21,9,21,12],[47,34,47,38],[48,34,48,38],[49,34,49,38],[41,29,41,30],[23,10,23,38],[27,20,27,24],[30,28,30,40],[31,26,31,40],[36,13,36,14],[36,23,36,24],[36,35,36,36],[44,27,44,28],[44,30,44,31],[23,5,23,9],[31,24,31,25],[6,32,6,33],[6,35,6,36],[22,18,22,24],[22,25,22,27],[22,28,22,29],[22,31,22,32],[21,14,21,17],[21,20,21,23],[6,23,6,29],[7,23,7,29],[6,30,6,31],[57,9,57,17],[57,20,57,23],[57,24,57,34],[58,9,58,17],[39,0,42,0],[39,1,42,4],[43,0,53,0],[43,1,53,4],[46,8,53,11],[54,0,61,0],[54,1,61,4],[56,9,56,17],[41,10,41,16],[59,14,59,16],[58,23,58,29],[58,32,58,33],[34,0,38,0],[34,1,38,4],[0,0,4,15],[6,17,6,20],[7,17,7,20],[0,18,4,40],[26,16,27,16],[26,17,27,19],[29,16,32,16],[29,17,32,19],[30,25,30,27],[7,2,7,3],[7,9,7,10],[6,38,6,39],[7,33,7,34],[7,39,7,40]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"この「生計維持調査票」は、被保険者(職員本人)であるあなたからみて、新たに被扶養者（家族）として申請される方および、既に被扶養者資格のある方との身分関係や生計維持関係(生活費等の依存度)を記入していただくものです。審査する上で重要な資料となりますので、具体的にわかりやすく記入をお願いします。"]
[]
[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,"※←データクリアを押すと、入力されているデータが削除されます。"]
[]
[]
[]
["下記の記入内容に間違いありません",null,null,null,null,null,null,null,null,null,null,null,null,"被 保 険 者",null,null,null,"（職員本人）",null,null,null,"氏名",null,null,null,null,null,null,null,null,"記入日",null,null,null,"年",null,null,"月",null,null,"日"]
["記号（　　　　　　　　）",null,null,null,"）",null,null,"番号（",null,null,null,"）",null,"扶養申請者",null,null,null,"　　被扶養者になろうと\n　　している人",null,null,null,"氏名",null,null,null,null,null,null,null,null,null,"年齢",null,null,null,"歳",null,"続柄"]
[]
[]
["該当する項目に✔または記入してください。必ず記入漏れがないようにお願いします。"]
[1,"今回、被扶養者として申請する理由をどちらか選んでください。"]
[]
[null,null,"被保険者（私）が任意継続被保険者となるため"]
[null,null,"被保険者（私）が定年して再雇用となるため"]
[]
[2,"扶養申請者の現在の状況"]
[]
[null,null,"無職"]
[null,null,"パート・アルバイト"]
[null,null,"学生のため（高校生以上は在学証明書または学生証のコピーを添付）"]
[null,null,null,null,"中学生以下",null,null,null,null,"高校生",null,null,null,null,"大学（院）生",null,null,null,null,null,"専門学校生"]
[null,null,null,null,null,null,null,null,null,"高校生以上の場合、",null,null,null,null,null,"学校名　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,"卒業予定",null,null,null,null,"年",null,null,"月"]
[null,null,"その他",null,null,"（具体的にご記入ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[3,"住居について"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"①","仕送り額"]
[null,null,"同一住宅に同居",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"万円／月"]
[]
[null,null,"２世帯住宅または共同住宅の別戸",null,null,null,null,null,null,null,null,null,null,null,null,null,"②","別居理由",null,null,null,"単身赴任",null,null,null,null,"通学"]
[null,null,"同一敷地内の別棟",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設入所等",null,null,null,"（施設名称）"]
[null,null,"別居",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,"具体的理由"]
[]
[4,"扶養申請者の今後の収入の有無について"]
["①","勤労収入"]
[null,null,null,null,null,null,null,"あり（直近三ヶ月の給与明細を添付）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なし"]
[null,null,null,null,null,null,null,null,"月平均労働日数",null,null,null,null,null,null,"日","(１日あたりの勤務時間",null,null,null,null,null,null,null,null,"時間)",null,null,"月平均給与(総額支給額)",null,null,null,null,null,null,null,null,"万円位/月"]
[null,null,null,null,null,null,null,null,"※申請者が自営業・農業の「専従者」の場合、こちらにご記入ください。"]
[null,null,null,null,null,null,null,null,"※働き始めて間もない等の理由で直近三ヶ月の実績がない方は雇用契約書を添付"]
["②","自営業収入"]
[null,null,null,null,null,null,null,"あり（直近の確定申告書A・B、収支内訳書の写を添付）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なし"]
[null,null,null,null,null,null,null,null,"業種",null,null,null,null,null,null,null,null,"/年間収入額（経費を差し引いていない額）",null,null,null,null,null,null,null,null,null,null,null,null,null,"万円（見込含）"]
[null,null,null,null,null,null,null,null,"※自営業を始めて間もない等の理由で確定申告関係書類がない方は売上等がわかる書類を添付"]
["③","年金収入"]
[null,null,null,null,null,null,null,"あり（支払通知書の写しを添付）",null,null,null,null,null,null,null,null,null,null,null,"今後１年以内に受給予定（",null,null,null,null,null,null,null,null,null,"年",null,null,"月から）",null,null,null,null,"なし"]
[]
[null,null,null,null,null,null,null,null,"\n年金の種類"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老齢年金",null,null,"（",null,"国民",null,null,"厚生",null,null,"その他",null,null,"）",null,null,null,"年額",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"遺族年金",null,null,"（",null,"国民",null,null,"厚生",null,null,"その他",null,null,"）",null,null,null,"年額",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"障害年金",null,null,"（",null,"国民",null,null,"厚生",null,null,"その他",null,null,"）",null,null,null,"年額",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"企業年金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人年金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,"（種類",null,null,null,null,null,null,null,null,null,null,"）",null,null,null,"年額",null,null,null,null,null,null,"円"]
[]
["④","その他収入"]
[null,null,null,null,null,null,null,"あり（証明する書類を添付）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なし"]
[null,null,null,null,null,null,null,null,null,"不動産収入（家賃収入など）",null,null,null,null,null,null,null,null,null,"（",null,null,"年分）",null,"年間収入額（経費を差し引いていない額）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"万円"]
[null,null,null,null,null,null,null,null,null,"配当所得",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,"万円"]
[null,null,null,null,null,null,null,null,null,"被保険者以外からの仕送り",null,null,null,null,null,null,null,null,null,"支援者氏名",null,null,null,null,null,null,null,null,null,null,"続柄（",null,null,null,"）",null,null,null,null,"万円"]
[null,null,null,null,null,null,null,null,null,"傷病手当金",null,null,null,null,"（傷病名　　　　",null,null,null,null,null,null,null,null,null,"/","受給開始",null,null,null,null,"年",null,null,"月～）",null,null,null,null,null,"万円"]
[null,null,null,null,null,null,null,null,null,"その他",null,null,"内容",null,null,null,null,null,null,"（",null,null,"年分）",null,"年間収入額（経費を差し引いていない額）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"万円"]
[]
[]
["事業所名証明欄",null,null,null,null,null,"※任意継続被保険者は記入不要"]
[null,"事業所扶養手当支給の有無",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"源泉徴収における扶養家族該当の有無"]
[null,"【","有","】","（支給　　開始　・　開始予定",null,null,null,null,null,null,null,null,"年",null,"月）","【","有","】","（　　該当　・　該当予定",null,null,null,null,null,null,null,null,null,"年",null,"月）"]
[null,"【","無","】","（理由",null,null,null,null,null,null,null,null,null,null,"）","【","無","】","（理由",null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,"□","この届出については、申請者本人（被保険者）が作成、または記載内容について本人が確認しています。※チェック必須"]
[null,"記載事項は、事実と相違ないことを証明します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,"年",null,"月",null,"日"]
["事業所名",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,"被保険者の年収額"]
[]
["事業主名",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,"万円"]
[]
[null,"静岡県農業団体健康保険組合　理事長　殿"]
["【備考】"]