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["健康保険"]
[]
["被扶養者(異動)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,"※←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。"]
[]
[]
[]
["被保険者欄","記号",null,null,null,null,null,"番号",null,null,null,null,null,null,null,"生年月日",null,"選択してください",null,null,"年",null,"月",null,"日","備考"]
[]
[null,"氏名","（フリガナ）",null,null,null,null,null,null,null,null,null,null,null,null,"取　得\n年月日",null,"選択してください",null,null,"年",null,"月",null,"日","収入\n(年収)",null,null,"万円"]
[]
[null,null,"（氏）",null,null,null,null,null,"（名）\n\n\n　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　㊞"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所",null,"〒　　　　　　　　",null,"ー"]
[]
["下記の者について\n※どちらかに〇",null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,"※削除の場合、個人番号の記入は不要です。"]
[]
["被扶養者欄","氏名","（フリガナ）",null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,"選択してください",null,null,"年",null,"月",null,"日","性別","選択してください"]
[]
[null,null,"（氏）",null,null,null,null,null,"（名）\n\n\n　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　㊞"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号"]
[]
[null,"続柄",null,null,"職業",null,null,"収入\n(年収)",null,null,null,"万円","被扶養者になった、又は\n除かれた日付と理由",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[null,"住所",null,"選択してください",null,"別居の場合",null,"〒",null,"－",null,null,null,null,null,null,null,"健保記入欄\n認定年月日",null,null,null,"9.令和",null,null,"年",null,"月",null,"日"]
[]
[null,"住民票\n住所",null,"選択してください",null,"〒",null,null,null,null,"都  道\n府  県",null,null,null,null,"市  区\n町  村",null,"備考"]
[]
[null,"被扶養者欄の住所と同じ場合、同上にチェックを入れてください。なお、その場合は隣の住所の記入は不要です。(他の被扶養者欄においても同様)"]
["被扶養者欄","氏名","（フリガナ）",null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,"選択してください",null,null,"年",null,"月",null,"日","性別","選択してください"]
[]
[null,null,"（氏）",null,null,null,null,null,"（名）\n\n\n　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　㊞"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号"]
[]
[null,"続柄",null,null,"職業",null,null,"収入\n(年収)",null,null,null,"万円","被扶養者になった、又は\n除かれた日付と理由",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[null,"住所",null,"選択してください",null,"別居の場合",null,"〒",null,"－",null,null,null,null,null,null,null,"健保記入欄\n認定年月日",null,null,null,"9.令和",null,null,"年",null,"月",null,"日"]
[]
[null,"住民票\n住所",null,"選択してください",null,"〒",null,null,null,null,"都  道\n府  県",null,null,null,null,"市  区\n町  村",null,"備考"]
[]
[]
["被扶養者欄","氏名","（フリガナ）",null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,"選択してください",null,null,"年",null,"月",null,"日","性別","選択してください"]
[]
[null,null,"（氏）",null,null,null,null,null,"（名）\n\n\n　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　㊞"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号"]
[]
[null,"続柄",null,null,"職業",null,null,"収入\n(年収)",null,null,null,"万円","被扶養者になった、又は\n除かれた日付と理由",null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[null,"住所",null,"選択してください",null,"別居の場合",null,"〒",null,"－",null,null,null,null,null,null,null,"健保記入欄\n認定年月日",null,null,null,"9.令和",null,null,"年",null,"月",null,"日"]
[]
[null,"住民票\n住所",null,"選択してください",null,"〒",null,null,null,null,"都  道\n府  県",null,null,null,null,"市  区\n町  村",null,"備考"]
[]
["【　事業主記載欄　】　事業主の確認により添付書類を省略した場合は、該当するものにチェックをしてください。"]
["□","収入に関する証明の添付が省略されている者は、所得税法上の控除対象配偶者（※）又は控除対象扶養親族であることを確認しました。"]
[null,"※　年末調整の際「配偶者控除」に該当する予定の配偶者"]
["□","被保険者との続柄に関する証明書類が省略されている者については、続柄を確認しています。(内縁関係の場合は省略できません)"]
["□","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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付年月日"]
["事業所\n所在地",null,"〒　",null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年",null,null,"月",null,null,"日提出"]
[]
[]
[]
["事業所\n名　称"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士の記載欄"]
[]
["事業主\n氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名等"]
[]
[]
["電話番号",null,null,null,null,"（",null,null,null,"）",null,null,null,null,null,"静岡県農業団体健康保険組合"]