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[null,"被扶養者異動届入力フォーム"]
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[null,"事業主記入欄","健康保険\n事業所記号"]
[null,null,"事業所\n所在地",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名 　称"]
[null,null,"事業主\n氏　 名"]
[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,")"]
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[null,"A.\n\n被\n保\n険\n者\n欄","提出日",null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日"]
[null,null,"被保険者\n整理番号"]
[null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,"(氏)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(名)"]
[null,null,"氏名"]
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[null,null,"個人番号"]
[null,null,"取得年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[null,null,"住所",null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,"-"]
[]
[]
[null,"B.\n\n配\n偶\n者\nで\nあ\nる\n被\n扶\n養\n者\n欄","届出内容",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください"]
[null,null,"※第３号被保険者関係届（３枚目）の提出は配偶者（第２号被保険者）に委任します"]
[null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,"(氏名)"]
[null,null,"氏名"]
[null,null,"生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"性別\n（続柄）",null,null,null,null,null,null,"選択してください"]
[null,null,"個人番号"]
[null,null,"外国籍",null,null,null,null,null,null,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,"(氏)",null,null,null,null,null,null,null,null,null,null,null,null,null,"(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,"外国人\n通称名"]
[null,null,"住所",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",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,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,{"$f":"IF(Q29=\"2.別居\",\"遠隔地（別居）開始申請書を提出してください。\",IF(BK30=\"住民票と居住地が異なる\",\"被保険者の住所を居住地の登録とします\",\"\"))","v":""}]
[null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,")"]
[null,null,"追加",null,null,null,null,null,"被扶養者\nになった日",null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"職業",null,null,null,null,null,null,"選択してください"]
[null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"収入\n（年収）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,"発行理由\n※右の要確認欄より該当理由\nの数字を選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,"【要確認】資格確認書の発行は以下の理由に該当する場合に限ります。\n　　　①マイナンバーカードを取得していない者、マイナンバーカードの返納者\n　　　②マイナンバーカードを保有しているが健康保険証利用登録を行っていない者、利用登録解除を申請した者、利用登録解除者\n　　　③マイナンバーカードの電子証明書の有効期限切れの者"]
[null,null,"削除\n・\n変更",null,null,null,null,null,"被扶養者\nでなくなった日",null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者証\n回収区分",null,null,null,null,null,null,"選択してください"]
[null,null,"海外居住者又は\n海外から国内に転入した場合",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください"]
[null,null,"海外特例要件に\n該当した日",null,null,null,null,null,null,null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"理由",null,null,null,null,null,null,"選択してください"]
[null,null,"海外特例要件に\n非該当となった日",null,null,null,null,null,null,null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"理由",null,null,null,null,null,null,"選択してください"]
[null,null,"備考"]
[]
[null,"C.\n\nそ\nの\n他\n被\n扶\n養\n者\n欄\n1","届出内容",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください"]
[null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,"(氏)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(名)",null,null,null,null,null,null,null,null,null,null,null,null,null,"性別",null,null,null,null,null,null,"選択してください"]
[null,null,"氏名"]
[null,null,"生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"続柄"]
[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,"住所",null,null,null,null,null,null,"選択してください"]
[null,null,"追加",null,null,null,null,null,"被扶養者\nになった日",null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"職業",null,null,null,null,null,null,"選択してください"]
[null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"収入\n（年収）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,"発行理由\n※右の要確認欄より該当理由\nの数字を選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,"【要確認】資格確認書の発行は以下の理由に該当する場合に限ります。\n　　　①マイナンバーカードを取得していない者、マイナンバーカードの返納者\n　　　②マイナンバーカードを保有しているが健康保険証利用登録を行っていない者、利用登録解除を申請した者、利用登録解除者\n　　　③マイナンバーカードの電子証明書の有効期限切れの者"]
[null,null,"削除\n・\n変更",null,null,null,null,null,"被扶養者\nでなくなった日",null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者証\n回収区分",null,null,null,null,null,null,"選択してください"]
[null,null,"備考"]
[]
[null,"C.\n\nそ\nの\n他\n被\n扶\n養\n者\n欄\n2","届出内容",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください"]
[null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,"(氏)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(名)",null,null,null,null,null,null,null,null,null,null,null,null,null,"性別",null,null,null,null,null,null,"選択してください"]
[null,null,"氏名"]
[null,null,"生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"続柄"]
[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,"住所",null,null,null,null,null,null,"選択してください"]
[null,null,"追加",null,null,null,null,null,"被扶養者\nになった日",null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,"職業",null,null,null,null,null,null,"選択してください"]
[null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"収入\n（年収）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,"発行理由\n※右の要確認欄より該当理由\nの数字を選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,"【要確認】資格確認書の発行は以下の理由に該当する場合に限ります。\n　　　①マイナンバーカードを取得していない者、マイナンバーカードの返納者\n　　　②マイナンバーカードを保有しているが健康保険証利用登録を行っていない者、利用登録解除を申請した者、利用登録解除者\n　　　③マイナンバーカードの電子証明書の有効期限切れの者"]
[null,null,"削除\n・\n変更",null,null,null,null,null,"被扶養者\nでなくなった日",null,null,null,null,null,null,null,"9．令和",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,"理由",null,null,null,null,null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者証\n回収区分",null,null,null,null,null,null,"選択してください"]
[null,null,"備考"]
[]
[]
[null,"社会保険労務士記載欄"]
[]
[null,"氏　名　等"]

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[null,null,null,null,null,null,"⑥",null,null,null,null,{"$f":"IF(入力フォーム!Q17=\"5．昭和\",\"○\",\"\")","v":""},null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑦",null,null,null,null,null,null,null,null,{"$f":"入力フォーム!BD17&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,null,null,null,null,null,"〒",null,{"$f":"入力フォーム!S18&\"\"","v":""},null,null,"-",{"$f":"入力フォーム!Z18&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,{"$f":"BO37","v":""},null,null,"-",{"$f":"BS37","v":""}]
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[]
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[null,null,null,null,null,null,null,null,null,null,null,"　（ﾌﾘｶﾞﾅ）",null,null,null,null,{"$f":"入力フォーム!T23&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　（ﾌﾘｶﾞﾅ）",null,null,null,null,{"$f":"Q48","v":""}]
[null,null,null,null,null,null,"氏名\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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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\n"]
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[null,null,null,null,null,null,null,null,null,null,null,"※第３号被保険者関係届（2枚目）の提出は配偶者（第２号被保険者）に委任します",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,{"$f":"入力フォーム!AY22&\"\"","v":""},null,null,null,null,null,"外国籍",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"外国人\n通称名",null,null,null,null,{"$f":"入力フォーム!AJ28&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AX28&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※第３号被保険者関係届（2枚目）の提出は配偶者（第２号被保険者）に委任します",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BC54","v":""},null,null,null,null,null,"外国籍",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"外国人\n通称名",null,null,null,null,{"$f":"CF54","v":""},null,null,null,null,null,null,null,null,null,null,{"$f":"CQ54","v":""}]
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[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q29=\"2.別居\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"M58","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BK30=\"住民票と居住地が異なる\",\" ☑住民票と居住地が異なる\",\"　□住民票と居住地が異なる\")","v":"　□住民票と居住地が異なる"}]
[null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",\"○\",\"\")","v":""},null,null,null,null,"⑨",null,null,null,null,null,"9.令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑩",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q33=\"1.配偶者の就職\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q33=\"4.収入減少\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑪",null,null,null,null,{"$f":"IF(入力フォーム!BB32=\"1.無職\",\"○\",\"\")","v":""},null,null,null,{"$f":"IF(入力フォーム!BB32=\"4.その他\",\"○\",\"\")","v":""},null,null,null,null,null,"⑫",null,null,null,{"$f":"入力フォーム!AV33&\"\"","v":""},null,null,null,null,null,null,"円",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",\"○\",\"\")","v":""},null,null,null,null,"⑨",null,null,null,null,null,"9.令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑩",null,null,null,null,null,null,null,{"$f":"AV60","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BI60","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"配偶者の加入制度",null,null,null,null,null,null,null,null,null,null,"３１．厚生年金保険・健康保険"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n（第3号被保険者）\nになった日",null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!W32,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!Z32,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!AE32,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!AH32,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!AM32,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!AP32,\"\")","v":""},null,null,"理由\n",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q33=\"2.婚姻\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q33=\"5.その他\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"職業",null,null,null,null,{"$f":"IF(入力フォーム!BB32=\"2.パート\",\"○\",\"\")","v":""},null,null,null,"(",{"$f":"入力フォーム!BI32&\"\"","v":""},null,null,null,")","収入\n（年収）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n（第3号被保険者）\nになった日",null,null,null,null,null,null,null,null,null,{"$f":"V62","v":""},null,null,{"$f":"Y62","v":""},null,null,{"$f":"AB62","v":""},null,null,{"$f":"AE62","v":""},null,null,{"$f":"AH62","v":""},null,null,{"$f":"AK62","v":""},null,null,"理由\n",null,null,null,null,null,null,null,{"$f":"AV62","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BI62","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q33=\"3.離職\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AB33&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB32=\"3.年金受給者\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AV64","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BK64","v":""}]
[]
[null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養削除\",\"○\",\"\")","v":""},null,null,null,null,"⑭",null,null,null,null,null,"9.令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑮",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q36=\"1.死亡\",\"○\",\"\")","v":""},null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q36=\"1.死亡\",入力フォーム!AB36,\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑬",null,null,null,null,null,{"$f":"IF(入力フォーム!Q34=\"発行が必要\",\"☑ 必要\",\"□ 必要\")","v":"□ 必要"},null,null,null,null,null,"理由",null,{"$f":"IF(入力フォーム!Q34=\"発行が必要\",IF(入力フォーム!AS34=\"①\",\"☑マイナンバーカード未保有\",\"□マイナンバーカード未保有\"),\"□マイナンバーカード未保有\")","v":"□マイナンバーカード未保有"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養削除\",\"○\",\"\")","v":""},null,null,null,null,"⑬",null,null,null,null,null,"9.令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑭",null,null,null,null,null,null,null,{"$f":"AV66","v":""},null,null,null,null,null,null,{"$f":"BC66","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n（第3号被保険者）でなくなった日",null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!W35&\"\"","v":""},null,null,{"$f":"入力フォーム!Z35&\"\"","v":""},null,null,{"$f":"入力フォーム!AE35&\"\"","v":""},null,null,{"$f":"入力フォーム!AH35&\"\"","v":""},null,null,{"$f":"入力フォーム!AM35&\"\"","v":""},null,null,{"$f":"入力フォーム!AP35&\"\"","v":""},null,null,"理由\n",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q36=\"2.離婚\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q36=\"4.障害認定\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,null,null,null,{"$f":"IF(入力フォーム!Q34=\"発行不要\",\"☑ 不要\",\"□ 不要\")","v":"□ 不要"},null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q34=\"発行が必要\",IF(入力フォーム!AS34=\"②\",\"☑保険証利用　未登録\",\"□保険証利用　未登録\"),\"□保険証利用　未登録\")","v":"□保険証利用　未登録"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n（第3号被保険者）でなくなった日",null,null,null,null,null,null,null,null,null,{"$f":"V68","v":""},null,null,{"$f":"Y68","v":""},null,null,{"$f":"AB68","v":""},null,null,{"$f":"AE68","v":""},null,null,{"$f":"AH68","v":""},null,null,{"$f":"AK68","v":""},null,null,"理由\n",null,null,null,null,null,null,null,{"$f":"AV68","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BI68","v":""}]
[null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養変更\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養変更\",\"○\",\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q36=\"3.就職・収入増加\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q36=\"5.その他\",\"○\",\"\")","v":""},null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q36=\"5.その他\",入力フォーム!AB36,\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q34=\"不明\",\"☑ 不明\",\"□ 不明\")","v":"□ 不明"},null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q34=\"発行が必要\",IF(入力フォーム!AS34=\"③\",\"☑電子証明書有効期限切れ\",\"□電子証明書有効期限切れ\"),\"□電子証明書有効期限切れ\")","v":"□電子証明書有効期限切れ"},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,null,null,null,null,{"$f":"AV70","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BI70","v":""},null,null,null,null,null,null,null,{"$f":"BP70","v":""}]
[]
[null,null,null,null,null,null,"右の⑰～⑳欄は、海外居住者又は海外から国内に転入した場合のみ、記入してください。",null,null,null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",\"○\",\"\")","v":""},null,null,null,null,"⑰",null,null,null,null,null,null,null,null,"　9. \n　令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑱",null,null,null,null,null,{"$f":"IF(入力フォーム!BB38=\"1.留学\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB38=\"4.海外婚姻\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備\n\n考",null,null,{"$f":"入力フォーム!Q40&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"右の⑰～⑳欄は、海外居住者又は海外から国内に転入した場合のみ、記入してください。",null,null,null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",\"○\",\"\")","v":""},null,null,null,null,"⑰",null,null,null,null,null,null,null,null,"　9. \n　令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑱",null,null,null,null,null,{"$f":"BB72","v":""},null,null,null,null,null,null,null,null,null,{"$f":"BL72","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備\n\n考",null,null,{"$f":"CD72","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"海外特例要件に\n該 当 し た 日",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",入力フォーム!W38,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",入力フォーム!Z38,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",入力フォーム!AE38,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",入力フォーム!AH38,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",入力フォーム!AM38,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"1.海外特例要件該当\",入力フォーム!AP38,\"\")","v":""},null,null,"理　　由\n",null,null,null,null,null,{"$f":"IF(入力フォーム!BB38=\"2.同行家族\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB38=\"5.その他\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"海外特例要件に\n該 当 し た 日",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AD74","v":""},null,null,{"$f":"AG74","v":""},null,null,{"$f":"AJ74","v":""},null,null,{"$f":"AM74","v":""},null,null,{"$f":"AP74","v":""},null,null,{"$f":"AS74","v":""},null,null,"理　　由\n",null,null,null,null,null,{"$f":"BB74","v":""},null,null,null,null,null,null,null,null,null,{"$f":"BL74","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB38=\"3.特定活動\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!BI38&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BB76","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"BN76","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",\"○\",\"\")","v":""},null,null,null,null,"⑲",null,null,null,null,null,null,null,null,"　9.\n　令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑳",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",\"○\",\"\")","v":""},null,null,null,null,"⑲",null,null,null,null,null,null,null,null,"　9.\n　令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑳"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB39=\"1.国内転入\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB39=\"1.国内転入\",入力フォーム!BI39,\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"BB79","v":""},null,null,null,null,null,null,null,null,null,null,{"$f":"BM79","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"海外特例要件に\n非該当となった日",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",入力フォーム!W39,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",入力フォーム!Z39,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",入力フォーム!AE39,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",入力フォーム!AH39,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",入力フォーム!AM39,\"\")","v":""},null,null,{"$f":"IF(入力フォーム!Q37=\"2.海外特例要件非該当\",入力フォーム!AP39,\"\")","v":""},null,null,"理　　由\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"海外特例要件に\n非該当となった日",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AD80","v":""},null,null,{"$f":"AG80","v":""},null,null,{"$f":"AJ80","v":""},null,null,{"$f":"AM80","v":""},null,null,{"$f":"AP80","v":""},null,null,{"$f":"AS80","v":""},null,null,"理　　由\n"]
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[]
[]
[]
[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,{"$f":"入力フォーム!T43&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AH43&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,null,null,null,{"$f":"IF(入力フォーム!Q45=\"5．昭和\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"③",null,null,null,{"$f":"IF(入力フォーム!BA43=\"1.男\",\"○\",\"\")","v":""},null,null,null,{"$f":"IF(入力フォーム!BA43=\"2.女\",\"○\",\"\")","v":""},null,null,null,"④",null,null,null,{"$f":"入力フォーム!BB45&\"\"","v":""},null,null,null,null,null,null,null,null,"※「長男」「次男」など明確に記入してください。",null,null,null,null,null,null,null,null,null,null,"川口工業健康保険組合の\n\n\n受付済（受付印の押された）扶養認定の事業主控えの写し\n\nまたは\n\n発行した”第３号被保険者”の保険証の写し\n\n\nのいずれかを添付の上、管轄の年金事務センターにご送付ください。"]
[]
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[null,null,null,null,null,null,"氏名",null,null,null,null,{"$f":"入力フォーム!T44&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AH44&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別",null,null,null,null,null,null,null,null,null,null,null,"続柄"]
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[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号"]
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[]
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[]
[null,null,null,null,null,null,null,null,null,null,null,"被扶養者\nになった日",null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!W47&\"\"","v":""},null,null,{"$f":"入力フォーム!Z47&\"\"","v":""},null,null,{"$f":"入力フォーム!AE47&\"\"","v":""},null,null,{"$f":"入力フォーム!AH47&\"\"","v":""},null,null,{"$f":"入力フォーム!AM47&\"\"","v":""},null,null,{"$f":"入力フォーム!AP47&\"\"","v":""},null,null,"理由",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q48=\"2.出生\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q48=\"5.同居\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"職業",null,null,null,{"$f":"IF(入力フォーム!BB47=\"2.パート\",\"○\",\"\")","v":""},null,null,null,{"$f":"入力フォーム!BI47&\"\"","v":""},null,null,null,"収入\n（年収）"]
[]
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[]
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[]
[null,null,null,null,null,null,null,null,null,null,null,"被扶養者\nでなくなった日",null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!W50&\"\"","v":""},null,null,{"$f":"入力フォーム!Z50&\"\"","v":""},null,null,{"$f":"入力フォーム!AE50&\"\"","v":""},null,null,{"$f":"入力フォーム!AH50&\"\"","v":""},null,null,{"$f":"入力フォーム!AM50&\"\"","v":""},null,null,{"$f":"入力フォーム!AP50&\"\"","v":""},null,null,"理由\n",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q51=\"2.収入増加\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q51=\"5.障害認定\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",{"$f":"IF(入力フォーム!Q51=\"7.その他\",入力フォーム!AB51,\"\")","v":""},null,null,null,null,null,")"]
[null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q42=\"扶養変更\",\"○\",\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q51=\"3.死亡\",\"○\",\"\")","v":""},null,null,null,null,null,"(",{"$f":"IF(入力フォーム!Q51=\"3.死亡\",入力フォーム!AB51,\"\")","v":""},null,null,null,null,null,null,null,")",null,{"$f":"IF(入力フォーム!Q51=\"6.別居\",\"○\",\"\")","v":""}]
[]
[null,null,null,null,null,null,"⑬",null,null,null,null,{"$f":"入力フォーム!Q52&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑭",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q49=\"発行が必要\",\"☑ 必要\",\"□ 必要\")","v":"□ 必要"},null,null,null,null,null,null,"理由",null,null,{"$f":"IF(入力フォーム!Q49=\"発行が必要\",IF(入力フォーム!AS49=\"①\",\"☑マイナンバーカード未保有\",\"□マイナンバーカード未保有\"),\"□マイナンバーカード未保有\")","v":"□マイナンバーカード未保有"}]
[]
[null,null,null,null,null,null,"備考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q49=\"発行不要\",\"☑ 不要\",\"□ 不要\")","v":"□ 不要"},null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q49=\"発行が必要\",IF(入力フォーム!AS49=\"②\",\"☑保険証利用　未登録\",\"□保険証利用　未登録\"),\"□保険証利用　未登録\")","v":"□保険証利用　未登録"}]
[]
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[]
[null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,{"$f":"入力フォーム!T55&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AH55&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②",null,null,null,null,{"$f":"IF(入力フォーム!Q57=\"5．昭和\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"③",null,null,null,{"$f":"IF(入力フォーム!BA55=\"1.男\",\"○\",\"\")","v":""},null,null,null,{"$f":"IF(入力フォーム!BA55=\"2.女\",\"○\",\"\")","v":""},null,null,null,"④",null,null,null,{"$f":"入力フォーム!BB57&\"\"","v":""},null,null,null,null,null,null,null,null,"※「長男」「次男」など明確に記入してください。"]
[]
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[null,null,null,null,null,null,"氏名",null,null,null,null,{"$f":"入力フォーム!T56&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AH56&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別",null,null,null,null,null,null,null,null,null,null,null,"続柄"]
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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤",null,null,null,null,{"$f":"入力フォーム!Q58&\"\"","v":""},null,null,{"$f":"入力フォーム!S58&\"\"","v":""},null,null,{"$f":"入力フォーム!U58&\"\"","v":""},null,null,{"$f":"入力フォーム!W58&\"\"","v":""},null,null,{"$f":"入力フォーム!Y58&\"\"","v":""},null,null,{"$f":"入力フォーム!AA58&\"\"","v":""},null,null,{"$f":"入力フォーム!AC58&\"\"","v":""},null,null,{"$f":"入力フォーム!AE58&\"\"","v":""},null,null,{"$f":"入力フォーム!AG58&\"\"","v":""},null,null,{"$f":"入力フォーム!AI58&\"\"","v":""},null,null,{"$f":"入力フォーム!AK58&\"\"","v":""},null,null,{"$f":"入力フォーム!AM58&\"\"","v":""},null,null,"⑥",null,null,null,null,{"$f":"IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\")","v":""},null,null,null,null,null,{"$f":"IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人\n番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[]
[null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q54=\"扶養追加\",\"○\",\"\")","v":""},null,null,null,null,"⑦",null,null,null,null,null,"9.令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑧",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q60=\"1.被保険者の就職\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q60=\"4.収入減少\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,{"$f":"IF(入力フォーム!BB59=\"1.無職\",\"○\",\"\")","v":""},null,null,{"$f":"IF(入力フォーム!BB59=\"4.その他\",\"○\",\"\")","v":""},null,null,null,null,"⑩",null,null,null,{"$f":"入力フォーム!AV60&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"被扶養者\nになった日",null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!W59&\"\"","v":""},null,null,{"$f":"入力フォーム!Z59&\"\"","v":""},null,null,{"$f":"入力フォーム!AE59&\"\"","v":""},null,null,{"$f":"入力フォーム!AH59&\"\"","v":""},null,null,{"$f":"入力フォーム!AM59&\"\"","v":""},null,null,{"$f":"入力フォーム!AP59&\"\"","v":""},null,null,"理由",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q60=\"2.出生\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q60=\"5.同居\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"職業",null,null,null,{"$f":"IF(入力フォーム!BB59=\"2.パート\",\"○\",\"\")","v":""},null,null,null,{"$f":"入力フォーム!BI59&\"\"","v":""},null,null,null,"収入\n（年収）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q60=\"3.離職\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q60=\"6.その他\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,{"$f":"入力フォーム!AB60&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB59=\"3.年金受給者\",\"○\",\"\")","v":""}]
[]
[null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q54=\"扶養削除\",\"○\",\"\")","v":""},null,null,null,null,"⑪",null,null,null,null,null,"9.令和",null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"⑫",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q63=\"1.就職\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AB78&\"\"","v":""},{"$f":"IF(入力フォーム!Q63=\"4.被保険者の離婚\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q63=\"7.その他\",\"○\",\"\")","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,"被扶養者\nでなくなった日",null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!W62&\"\"","v":""},null,null,{"$f":"入力フォーム!Z62&\"\"","v":""},null,null,{"$f":"入力フォーム!AE62&\"\"","v":""},null,null,{"$f":"入力フォーム!AH62&\"\"","v":""},null,null,{"$f":"入力フォーム!AM62&\"\"","v":""},null,null,{"$f":"入力フォーム!AP62&\"\"","v":""},null,null,"理由\n",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q63=\"2.収入増加\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q63=\"5.障害認定\",\"○\",\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",{"$f":"IF(入力フォーム!Q63=\"7.その他\",入力フォーム!AB63,\"\")","v":""},null,null,null,null,null,")"]
[null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q54=\"扶養変更\",\"○\",\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q63=\"3.死亡\",\"○\",\"\")","v":""},null,null,null,null,null,"(",{"$f":"IF(入力フォーム!Q63=\"3.死亡\",入力フォーム!AB63,\"\")","v":""},null,null,null,null,null,null,null,")",null,{"$f":"IF(入力フォーム!Q63=\"6.別居\",\"○\",\"\")","v":""}]
[]
[null,null,null,null,null,null,"⑬",null,null,null,null,{"$f":"入力フォーム!Q64&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑭",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"発行が必要\",\"☑ 必要\",\"□ 必要\")","v":"□ 必要"},null,null,null,null,null,null,"理由",null,null,{"$f":"IF(入力フォーム!Q61=\"発行が必要\",IF(入力フォーム!AS61=\"①\",\"☑マイナンバーカード未保有\",\"□マイナンバーカード未保有\"),\"□マイナンバーカード未保有\")","v":"□マイナンバーカード未保有"}]
[]
[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,"資格確認書\n発行要否",null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"発行不要\",\"☑ 不要\",\"□ 不要\")","v":"□ 不要"},null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"発行が必要\",IF(入力フォーム!AS61=\"②\",\"☑保険証利用　未登録\",\"□保険証利用　未登録\"),\"□保険証利用　未登録\")","v":"□保険証利用　未登録"}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"不明\",\"☑ 不明\",\"□ 不明\")","v":"□ 不明"},null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"発行が必要\",IF(入力フォーム!AS61=\"③\",\"☑電子証明書有効期限切れ\",\"□電子証明書有効期限切れ\"),\"□電子証明書有効期限切れ\")","v":"□電子証明書有効期限切れ"}]
[]
[]
[]
[]
[]
[]
[]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　"]

{"sheet":"Sheet1","index":2,"n_rows":10,"n_cols":13,"rows_kept":10,"cut":false,"hidden":true,"merged":[[4,8,9,8]]}
[]
[null,"常務理事","事務局長","次　長","課　長","担当課長","係　長","係"]
[]
[]
[null,null,null,null,null,null,null,null,"健保処理欄","発行書類","確認","出力日","発送方法"]
[null,null,null,null,null,null,null,null,null,"・資格情報のお知らせ",null,"/","翌日以降"]
[null,null,null,null,null,null,null,null,null,"・決定通知",null,"/","翌日以降"]
[null,null,null,null,null,null,null,null,null,"・資格確認書　配偶者","有　無　不明","/","郵送　窓口"]
[null,null,null,null,null,null,null,null,null,"・資格確認書　①","有　無　不明","/","郵送　窓口"]
[null,null,null,null,null,null,null,null,null,"・資格確認書　②","有　無　不明","/","郵送　窓口"]

{"sheet":"記入方法等","index":3,"n_rows":69,"n_cols":33,"rows_kept":69,"cut":false,"hidden":false,"merged":[[66,1,66,55],[67,1,67,55],[68,1,68,55],[60,1,60,100],[61,1,61,100],[62,1,62,100],[63,1,63,99],[64,1,64,99],[65,1,65,55],[59,1,59,100],[51,1,51,14],[51,17,51,100],[52,1,52,17],[52,21,52,100],[53,1,53,16],[53,17,53,100],[54,17,54,100],[55,17,55,100],[56,17,56,100],[57,17,57,100],[58,17,58,100],[47,17,47,100],[48,1,48,16],[48,17,48,100],[49,17,49,100],[50,1,50,14],[50,17,50,100],[46,17,46,100],[39,1,39,14],[39,17,39,100],[40,1,40,24],[40,27,40,99],[42,1,42,24],[42,27,42,99],[43,1,43,99],[44,1,44,14],[44,17,44,99],[45,1,45,14],[45,17,45,100],[38,1,38,29],[38,32,38,99],[28,28,28,100],[29,17,29,100],[30,1,30,14],[30,17,30,100],[31,17,31,100],[32,1,32,16],[32,17,32,100],[33,17,33,100],[34,17,34,100],[35,17,35,100],[36,17,36,100],[37,17,37,100],[27,17,27,100],[20,1,20,16],[20,17,20,100],[21,1,21,14],[21,17,21,100],[22,17,22,100],[23,1,23,14],[23,17,23,100],[24,1,24,14],[24,17,24,100],[25,1,25,14],[25,17,25,100],[26,17,26,100],[19,17,19,100],[12,1,12,14],[12,17,12,100],[13,1,13,14],[13,17,13,100],[14,17,14,100],[15,1,15,14],[15,17,15,100],[16,1,16,14],[16,17,16,100],[17,1,17,100],[18,1,18,14],[18,17,18,100],[11,1,11,14],[11,17,11,100],[0,1,2,101],[3,1,3,99],[5,1,5,9],[6,1,6,14],[6,17,6,100],[7,17,7,100],[8,1,8,99],[9,1,9,14],[9,17,9,100],[10,1,10,14],[10,17,10,100]]}
[null," この届書は、『健康保険被扶養者（異動）届』と『国民年金第３号被保険者関係届』が一体化した様式となり、「被扶養者になった\n 場合」「被扶養者でなくなった場合」、「被扶養者情報を変更する場合」にご提出いただくものです。\n※扶養追加の際は「被扶養者現況申請書」も必ずご提出ください。"]
[]
[]
[null,"・配偶者の扶養認定・削除の場合は、年金機構へ『国民年金第３号被保険者関係届』のご提出を合わせてお願いいたします。"]
[]
[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,"事業所記号は右図を参照し、新規適用時または名称･所在地変更時に付された記号をご記入ください。 　"]
[]
[null,"＜A.被保険者欄＞①～⑤、⑧は必ずご記入ください。該当の場合は⑥～⑦をご記入ください。"]
[null,"①被保険者整理番号",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ご記入ください。被保険者資格取得届と同時に提出する場合は記入不要です。"]
[null,"②氏名",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記入してください。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,"年号は該当する番号を〇で囲んでください。生年月日は右図のようにご記入ください。　　　　　　　　　　　　　　　　　　　"]
[null,"⑤個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"個人番号をご記入ください。"]
[null,"⑥取得年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"被保険者が健康保険に加入した日付をご記入ください。"]
[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』と同時に提出する場合は、『被保険者資格取得届』の取得年月日と同日になります。"]
[null,"⑦標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"現在の標準報酬月額をご記入ください。被保険者資格取得届と同時に提出する場合は記入不要です。"]
[null,"⑧住所",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。"]
[null,"＜B.配偶者である被扶養者欄（第３号被保険者）＞①～④、⑦～⑧は必ずご記入ください。該当の場合は⑨～⑬を、非該当･変更の場合は⑭～⑮をご記入ください。"]
[null,"①氏名（届出人の欄）",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"住民票に登録されている氏名および配偶者が被保険者を通じて事業主にこの届書を提出する日付をご記入ください。　　　　　　　　　　　　　"]
[null,"　　　　　　　  　　　   　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なお、配偶者が20歳未満または60歳以上の場合は第3号被保険者に該当しないため、届出日の記入および押印は不要です。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「第3号被保険者関係届（3枚目）の提出は配偶者（第2号被保険者）に委任します□」の□に✔を付してください。"]
[null,"③性別（続柄）",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"該当する番号を〇で囲んでください。　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,"                       　 　　 　  　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"内縁関係にある場合は、「3. 夫(未届)」「4. 妻(未届)」のいずれかを○で囲み、下記添付書類をご提出ください。　　"]
[null,"④個人番号",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。"]
[null,"⑥外国人通称名",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"氏名等について、通称名での登録を希望する場合は住民票に登録された通称名を記入し、住民票の写しをご提出ください。"]
[null,"⑦住所",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"被保険者と同居または別居のいずれかを〇で囲み、住民票の住所をご記入ください。別居の場合は、別途「遠隔地（別居）"]
[null,"　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"開始・終了申請書」および所定の添付書類を提出してください。「海外特例要件」に該当するときは、該当していることを"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"証する書類の提出が必要になります。"]
[null,"⑨被扶養者(第3号被保険者)になった日",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,"：","被保険者の社会保険加入と同時に提出する場合は「⑥取得年月日」と同日、それ以外の場合は実際に被扶養者"]
[null,"            　　　　　 　    　       ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(第3号被保険者)になった日をご記入ください。"]
[null,"⑫収入(年収)",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"今後1年間の年間収入見込み額をご記入ください。収入には、非課税対象のもの(障害・遺族年金、失業給付等)も含みます。　　　　　　　　　　　　　　"]
[null,"           　　　      　 　　       ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"非課税対象の収入がある場合は、受取金額が確認できる書類のコピーを添付の上、「⑯備考」に具体的な内容をご記入ください。"]
[null,"⑬資格確認書発行要否",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書の発行が必要な場合（※）は「□発行が必要」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,"※以下に該当する場合に限ります。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　・マイナンバーカードを取得していない者、マイナンバーカードの返納者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　・マイナンバーカードを保有しているが健康保険証利用登録を行っていない者、利用登録解除を申請した者、利用登録解除者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　・マイナンバーカードの電子証明書の有効期限切れの者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"上記の項目以外の理由で資格確認書の発行をご希望の方は、別途「資格確認書交付申請書」よりご申請ください。"]
[null,"⑭被扶養者(第3号被保険者)でなくなった日　",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,"死亡による場合は死亡日の翌日を、それ以外の場合は非該当になった当日の日付をご記入ください。"]
[null,"⑯備考",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"被扶養者情報に変更がある場合は、変更の内容とその理由をご記入ください。"]
[null,"⑰海外特例要件に該当した日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"被保険者の社会保険加入と同時に提出する場合は「Ａ．被保険者欄」の「⑥取得年月日」と同日、それ以外の"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"場合は海外居住者となった日をご記入ください。"]
[null,"⑲海外特例要件に非該当となった日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"国内に転入した場合は、当日の日付をご記入ください。"]
[null,"＜C.その他の被扶養者欄＞①～⑥は必ずご記入ください。また該当の場合は⑦～⑩、⑭を、非該当・変更の場合は⑪～⑫をご記入ください。"]
[null,"⑤個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"必ず本人確認を行ったうえで、個人番号をご記入ください。"]
[null,"⑥住所",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"被保険者と同居または別居のいずれかを〇で囲んでください。別居の場合は、別途「遠隔地（別居）開始・終了申請書」"]
[null,"　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"および所定の添付書類を提出してください。「海外特例要件」に該当するときは、該当していることを証する書類の提出が"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要になります。"]
[null,"⑦被扶養者になった日：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者の社会保険加入と同時に提出する場合は「⑥取得年月日」と同日、それ以外の場合は実際に被扶養者になった日を　　　　　　　　  "]
[null,"                        ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ご記入ください。"]
[null,"⑧理由",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"被扶養者となった理由を〇で囲んでください。"]
[null,"⑩収入(年収)",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,"今後1年間の年間収入見込み額をご記入ください。収入には、非課税対象のもの(障害・遺族年金、失業給付等)も含みます。　　　　　　　　　　　　　"]
[null,"⑪被扶養者でなくなった日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"死亡による場合は死亡日の翌日を、それ以外の場合は非該当になった当日の日付をご記入ください。"]
[null,"⑭資格確認書発行要否",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書の発行が必要な場合（※）は「□発行が必要」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,"※以下に該当する場合に限ります。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　・マイナンバーカードを取得していない者、マイナンバーカードの返納者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　・マイナンバーカードを保有しているが健康保険証利用登録を行っていない者、利用登録解除を申請した者、利用登録解除者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　・マイナンバーカードの電子証明書の有効期限切れの者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"上記の項目以外の理由で資格確認書の発行をご希望の方は、別途「資格確認書交付申請書」よりご申請ください。"]
[null,"添付書類"]
[null,"1.扶養認定を受ける方の身分関係（続柄）、同一世帯の確認のため、被扶養者現況申請書を添付してください。（内縁関係にある場合は、両人の戸籍謄（妙）"]
[null,"　本も添付してください。）※事業主が身分関係（続柄）等を確認し、署名欄の□に✔を付してください。"]
[null,"2.「被扶養者現況申請書」裏面を参考に扶養認定を受ける方の扶養認定日及び収入金額が確認できる書類を添付してください。"]
[null,"3.被保険者と扶養認定を受ける方が別居の場合、別途「遠隔地（別居）開始・終了申請書」および所定の添付書類を提出してください。"]
[null,"　なお、仕送り額は扶養認定を受ける方の収入を上回る必要があります。"]
[null,"4.被扶養者の非該当・変更の場合は、被保険者証等の返却が必要です。"]
[null,"　やむを得ず返却できない場合は「証(書)紛失届」を添付してください。"]
[null,"　なお、非該当の場合は、右記を参考に被扶養者でなくなったことを確認できる"]
[null,"　書類を添付してください。"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被扶養者現況申請書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"扶養追加の際に異動届と合わせてご提出ください"]
[]
[]
[null,"◎被保険者がご記入ください。"]
[]
[null,"被保険者　記号・番号",null,null,null,null,null,null,null,null,null,null,"被保険者氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"◆添付資料の詳細は、２枚目をご参照ください。　\n※個々の状況により別途資料をご提出いただく場合がありますので、ご了承ください。"]
[null,{"$f":"入力フォーム!Q4&\"\"","v":""},null,null,null,null,"-",{"$f":"入力フォーム!Q12&\"\"","v":""},null,null,null,null,{"$f":"入力フォーム!T14&\"　\"&入力フォーム!AH14","v":"　"}]
[]
[]
[null,"今回申請する被扶養対象者について該当する続柄の箇所に記入し、該当する添付資料をすべて添付してください。"]
[]
[null,"続柄",null,null,null,null,null,null,null,"被扶養者氏名",null,null,null,null,null,null,null,null,null,null,null,null,"住所",null,null,null,null,null,null,null,"収入",null,null,null,null,null,null,null,"添付資料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"添付書類\nチェック欄"]
[null,"配偶者",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!T24,\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q29=\"1.同居\",\"○\",\"\")","v":""},null,null,null,{"$f":"IF(入力フォーム!Q29=\"2.別居\",\"○\",\"\")","v":""},null,null,null,"年額",null,null,null,null,null,null,"円","　１. 日付確認資料（裏面①）",null,null,null,null,null,null,null,null,null,null,null,null,"\n計２点",null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q21=\"扶養追加\",入力フォーム!AV33,\"\")","v":""},null,null,null,null,null,null,null,"　２. 収入確認資料（裏面②）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※別居の場合は、別途「遠隔地（別居）開始申請書」をご提出ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　添付不要の場合も☑ ↑↑"]
[]
[null,"続柄",null,null,null,null,null,null,null,"被扶養者氏名",null,null,null,null,null,null,null,null,null,null,null,null,"住所",null,null,null,null,null,null,null,"収入",null,null,null,null,null,null,null,"添付資料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"添付書類\nチェック欄"]
[null,"子【実子・養子※１】\n被扶養者（１）",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB45=\"長男\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"二男\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"次男\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"三男\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"四男\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"五男\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"長女\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"次女\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"二女\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"三女\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"四女\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"五女\",入力フォーム!T44&\"　\"&入力フォーム!AH44,IF(入力フォーム!BB45=\"養子\",入力フォーム!T44&\"　\"&入力フォーム!AH44,\"\")))))))))))))","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB45=\"長男\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"二男\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"次男\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"三男\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"四男\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"五男\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"長女\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"次女\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"二女\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"三女\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"四女\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"五女\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB45=\"養子\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),\"\")))))))))))))","v":""},null,null,null,{"$f":"IF(入力フォーム!BB45=\"長男\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"二男\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"次男\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"三男\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"四男\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"五男\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"長女\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"次女\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"二女\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"三女\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"四女\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"五女\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB45=\"養子\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),\"\")))))))))))))","v":""},null,null,null,"年額",null,null,null,null,null,null,"円","　１. 日付確認資料（裏面①）",null,null,null,null,null,null,null,null,null,null,null,null,"\n計２点",null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!AV48=\"\",\"\",IF(入力フォーム!BB45=\"長男\",入力フォーム!AV48,IF(入力フォーム!BB45=\"二男\",入力フォーム!AV48,IF(入力フォーム!BB45=\"次男\",入力フォーム!AV48,IF(入力フォーム!BB45=\"三男\",入力フォーム!AV48,IF(入力フォーム!BB45=\"四男\",入力フォーム!AV48,IF(入力フォーム!BB45=\"五男\",入力フォーム!AV48,IF(入力フォーム!BB45=\"長女\",入力フォーム!AV48,IF(入力フォーム!BB45=\"次女\",入力フォーム!AV48,IF(入力フォーム!BB45=\"二女\",入力フォーム!AV48,IF(入力フォーム!BB45=\"三女\",入力フォーム!AV48,IF(入力フォーム!BB45=\"四女\",入力フォーム!AV48,IF(入力フォーム!BB45=\"五女\",入力フォーム!AV48,IF(入力フォーム!BB45=\"養子\",入力フォーム!AV48,\"\"))))))))))))))","v":""},null,null,null,null,null,null,null,"　２. 収入確認資料（裏面②）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※別居の場合は、別途「遠隔地（別居）開始申請書」をご提出ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　添付不要の場合も☑ ↑↑"]
[null,"子【実子・養子※１】\n被扶養者（2）",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB57=\"長男\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"二男\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"次男\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"三男\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"四男\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"五男\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"長女\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"次女\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"二女\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"三女\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"四女\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"五女\",入力フォーム!T56&\"　\"&入力フォーム!AH56,IF(入力フォーム!BB57=\"養子\",入力フォーム!T56&\"　\"&入力フォーム!AH56,\"\")))))))))))))","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB57=\"長男\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"二男\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"次男\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"三男\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"四男\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"五男\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"長女\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"次女\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"二女\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"三女\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"四女\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"五女\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),IF(入力フォーム!BB57=\"養子\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),\"\")))))))))))))","v":""},null,null,null,{"$f":"IF(入力フォーム!BB57=\"長男\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"二男\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"次男\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"三男\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"四男\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"五男\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"長女\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"次女\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"二女\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"三女\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"四女\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"五女\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),IF(入力フォーム!BB57=\"養子\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),\"\")))))))))))))","v":""},null,null,null,"年額",null,null,null,null,null,null,"円","　１. 日付確認資料（裏面①）",null,null,null,null,null,null,null,null,null,null,null,null,"\n計２点",null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!AV60=\"\",\"\",IF(入力フォーム!BB57=\"長男\",入力フォーム!AV60,IF(入力フォーム!BB57=\"二男\",入力フォーム!AV60,IF(入力フォーム!BB57=\"次男\",入力フォーム!AV60,IF(入力フォーム!BB57=\"三男\",入力フォーム!AV60,IF(入力フォーム!BB57=\"四男\",入力フォーム!AV60,IF(入力フォーム!BB57=\"五男\",入力フォーム!AV60,IF(入力フォーム!BB57=\"長女\",入力フォーム!AV60,IF(入力フォーム!BB57=\"次女\",入力フォーム!AV60,IF(入力フォーム!BB57=\"二女\",入力フォーム!AV60,IF(入力フォーム!BB57=\"三女\",入力フォーム!AV60,IF(入力フォーム!BB57=\"四女\",入力フォーム!AV60,IF(入力フォーム!BB57=\"五女\",入力フォーム!AV60,IF(入力フォーム!BB57=\"養子\",入力フォーム!AV60,\"\"))))))))))))))","v":""},null,null,null,null,null,null,null,"　２. 収入確認資料（裏面②）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※別居の場合は、別途「遠隔地（別居）開始申請書」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,null,null,null,null,"　　　添付不要の場合も☑ ↑↑"]
[null,"◆ 被保険者の配偶者に\n ついてご記入ください。\n\n※配偶者が扶養に入っている\n　　場合は、省略可",null,null,null,null,null,null,null,null,null,null,null,"配偶者あり\n(内縁含む）",null,null,null,null,null,null,null,"配偶者\n氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"収入",null,null,"\n年額",null,null,null,null,null,null,"円","職業",null,null,"□1.正社員",null,null,null," □4.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,"□2.パート",null,null,null,"(",null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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.年金受給者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"配偶者なし",null,null,null,null,null,null,null,"該当するものに\n☑してください\n→",null,null,null,null,null,null,null,"　□　　1. 未婚",null,null,null,null,null,null," 3.離婚の場合\n →",null,null,null,null,"養育費　月額",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,"　□　　2. 死別"]
[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,null,null,"　□　　3. 離婚"]
[null,"※１）実子・養子以外の子（養子縁組していない配偶者の連れ子等）はその他親族にご記入ください。"]
[null,"続柄",null,null,null,null,null,null,null,"被扶養者氏名",null,null,null,null,null,null,null,null,null,null,null,null,"住所",null,null,null,null,null,null,null,"収入",null,null,null,null,null,null,null,"添付資料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"添付書類\nチェック欄"]
[null,"その他親族\n被扶養者（１）",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB45=\"\",\"\",IF(J18=\"\",入力フォーム!T44&\" \"&入力フォーム!AH44,\"\"))","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB45=\"\",\"\",IF(W18=\"\",IF(入力フォーム!AV46=\"1.同居\",\"○\",\"\"),\"\"))","v":""},null,null,null,{"$f":"IF(入力フォーム!BB45=\"\",\"\",IF(AA18=\"\",IF(入力フォーム!AV46=\"2.別居\",\"○\",\"\"),\"\"))","v":""},null,null,null,"年額",null,null,null,null,null,null,"円","　１. 日付確認資料（裏面①）",null,null,null,null,null,null,null,null,null,null,null,null,"計３点",null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB45=\"\",\"\",IF(入力フォーム!AV48=\"\",\"\",IF(AE19=\"\",入力フォーム!AV48,\"\")))","v":""},null,null,null,null,null,null,null,"　２. 収入確認資料（裏面②）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　３. 世帯全員の住民票",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※別居の場合は、別途「遠隔地（別居）開始申請書」をご提出ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　添付不要の場合も☑ ↑↑"]
[null,"その他親族\n被扶養者（２）",null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB57=\"\",\"\",IF(J21=\"\",入力フォーム!T56&\"　\"&入力フォーム!AH56,\"\"))","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB57=\"\",\"\",IF(W21=\"\",IF(入力フォーム!AV58=\"1.同居\",\"○\",\"\"),\"\"))","v":""},null,null,null,{"$f":"IF(入力フォーム!BB57=\"\",\"\",IF(AA21=\"\",IF(入力フォーム!AV58=\"2.別居\",\"○\",\"\"),\"\"))","v":""},null,null,null,"年額",null,null,null,null,null,null,"円","　１. 日付確認資料（裏面①）",null,null,null,null,null,null,null,null,null,null,null,null,"計３点",null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!BB57=\"\",\"\",IF(入力フォーム!AV60=\"\",\"\",IF(AE22=\"\",入力フォーム!AV60,\"\")))","v":""},null,null,null,null,null,null,null,"　２. 収入確認資料（裏面②）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,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. 世帯全員の住民票",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※別居の場合は、別途「遠隔地（別居）開始申請書」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,null,null,null,null,"　　　添付不要の場合も☑ ↑↑"]
[null,"扶養に入っている者以外で\n同居している方について\nご記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"同居人\n氏　名",null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,null,"収入",null,null,"\n年額",null,null,null,null,null,null,"円","職業",null,null,"□1.正社員",null,null,null," □4.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,"□2.パート",null,null,null,"(",null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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.年金受給者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"同居人\n氏　名",null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,null,"収入",null,null,"\n年額",null,null,null,null,null,null,"円","職業",null,null,"□1.正社員",null,null,null," □4.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,"□2.パート",null,null,null,"(",null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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.年金受給者"]
[]
[null,"下記をご確認いただき、ご署名ください",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,"・事業主様がご確認のうえ、下記署名欄の確認欄に✔をお願い致します。"]
[]
[null,"被扶養者（異動）届、被扶養者現況申請書、遠隔地（別居）開始届に\n虚偽がある場合、また後日提出予定の資料が用意できない場合には\n認定日に遡って扶養取消となっても異議申し立てしません。\nまた、当組合によるマイナンバーの情報照会にて扶養の要件を満たさ\nない等、確認された場合には、速やかに届出を提出します。\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,"確認欄"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・公的書類にて、身分関係（続柄）、同一世帯について相違がないことを確認しました。\n　　※公的書類（例）戸籍謄本、住民票等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・被扶養者の収入、生計維持関係について上記内容と相違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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所所在地",null,null,null,null,null,null,{"$f":"入力フォーム!Q6&\"\"","v":""}]
[null,null,null,"（被保険者氏名）",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,"事業所名",null,null,null,null,null,null,{"$f":"入力フォーム!Q7&\"\"","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事業主",null,null,null,null,null,null,{"$f":"入力フォーム!Q8&\"\"","v":""}]
[null,"被扶養者の認定基準"]
[]
[null,null,"被扶養者となるためには次の要件をすべて満たしていることが必要です。"]
[null,null,"○",null,"被保険者からみて3親等内の親族であり、かつ主として被保険者の収入によって生計を維持されていること。"]
[null,null,"○",null,"年間収入が１３０万円（６０歳以上又は障害年金受給者の方は１８０万円）未満でかつ被保険者の収入の２分の１未満であること。"]
[null,null,null,null,"※","　年間収入とは、将来に向かって受けるであろう年間予定収入額となります。"]
[null,null,null,null,null,"・１年を超えない有期契約の場合であっても年間ベースに直して計算し判断します。"]
[null,null,null,null,null,"・雇用保険は、日額で判断します。"]
[null,null,null,null,"６０歳未満",null,null,null,null,null,null,null,null,null,null,null,"月額１０８，333円×１２ヶ月＝１，２９９，９９６円　　日額3，６１２円未満"]
[null,null,null,null,"６０歳以上",null,null,null,null,null,null,null,null,null,null,null,"月額１4９，９９９円×１２ヶ月＝１，７９９，９８８円　　日額５，０００円未満"]
[null,null,null,null,"※給与収入の場合・・・交通費等を含む総支給額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年金収入の場合・・・介護保険料、所得税額等控除前の年金支払額"]
[null,null,"○",null,"被保険者と別居している場合は、被保険者の仕送り額より被扶養者の収入が少ないこと。"]
[]
[null,"添付書類詳細"]
[]
[null,null,"① 日付確認資料（写しでの提出可）"]
[null,null,null,"本人取得による認定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　日付確認資料の添付不要"]
[null,null,null,"出生による認定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　日付確認資料の添付不要"]
[null,null,null,"結婚による認定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　結婚した日がわかる書類（婚姻届の受理証、戸籍謄本等）"]
[null,null,null,"同居開始による認定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　世帯全員の住民票"]
[null,null,null,"退職による認定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職日がわかる書類（退職証明書、雇用保険離職票、健康保険資格喪失通知書等）"]
[null,null,null,"雇用形態変更による認定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　契約変更後の雇用契約書　または　健康保険資格喪失確認通知書\n　または　被扶養者の勤め先の事業主による証明"]
[null,null,null,"収入減少による認定"]
[null,null,null,"雇用保険受給終了による認定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　雇用保険受給資格者証（支給終了と印字があるもの）"]
[null,null,null,"※認定日について、事由発生日から１カ月を超える受付（当組合到着日）の場合は、原則当組合に申請書類が到着した日で認定といたします。"]
[null,null,null,"　　ただし、出生が扶養の事由である場合は、出生日を扶養認定日とします。"]
[null,null,null,"※書類到着日での認定の場合は日付確認資料の添付は不要です。被扶養者異動届の備考欄に「到着日での認定」とご記入下さい。"]
[]
[null,null,"② 収入確認資料（写しでの提出可）"]
[null,null,null,"※複数該当する場合は、すべてご用意ください。"]
[null,null,null,"学生の場合",null,null,null,null,null,null,null,null,null,null,null,null,null,"　学生証（高校生の場合、被扶養者異動届の備考欄に高校名を記入することで省略可能）\n　※中学生以下は添付不要"]
[null,null,null,"パート・アルバイトなど",null,null,null,null,null,null,null,null,null,null,null,null,null,"　直近3か月分の給与明細　または　雇用契約書"]
[null,null,null,"雇用形態変更・収入減少の場合",null,null,null,null,null,null,null,null,null,null,null,null,null,"　雇用契約書　または　収入減少月以後3ヶ月分の給与明細\n　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　※初月分のみ認定時に提出、残り2ヶ月分は後日必ず提出すること"]
[null,null,null,"傷病手当金を受給中",null,null,null,null,null,null,null,null,null,null,null,null,null,"　給付金決定通知書（傷病手当金に関するもの）"]
[null,null,null,"年金受給中\n（障害年金、企業年金、個人年金等含む）",null,null,null,null,null,null,null,null,null,null,null,null,null,"　直近の年金額がわかる書類（年金額改定通知書、年金振込通知書等）\n　※当組合での企業年金の収入の考え方\n　　　　　【受給金額】－【必要経費】＝【収入】　　　　　　備考：退職一時金等（継続的に得られないもの）は収入には含みません"]
[null,null,null,"現在収入がない場合\n（以前から勤めていない場合）",null,null,null,null,null,null,null,null,null,null,null,null,null,"　最新の非課税証明書　（収入が0円であることの確認）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※非課税証明書に金額がある場合　→　直近に勤めていた勤務先の退職日がわかる書類\n                                                                （源泉徴収票、退職証明書、雇用保険離職票、健康保険資格喪失通知書等）"]
[null,null,null,"現在収入がない場合\n（今回退職を事由に認定の場合）",null,null,null,null,null,null,null,null,null,null,null,null,null,"　収入確認資料の添付不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※１）雇用保険の失業給付を受給予定で受給金額が認定基準を超える場合は、受給開始日から被扶養者認定を\n　　　　削除する必要がございます。受給開始日以降に扶養削除の届出をご提出ください。\n　※２）受給開始日、受給金額につきまして、当組合にてマイナンバーによる情報照会にて確認させていただきます。"]
[null,null,null,"その他、継続的な収入がある場合",null,null,null,null,null,null,null,null,null,null,null,null,null,"　確定申告書及び青色申告決算書（写）　　必要に応じ「直接的必要経費申告書」\n　　又は、その他収入額が確認できる帳簿書類等\n　※利子・配当収入は税金控除前の金額が収入となります"]
[null,null,null," 　例：事業収入（自営業、農業）、\n　　　　 不動産収入、利子・配当収入など"]
[null,null,null,"不明点がある場合や、いずれにも該当しない場合は当組合にご確認ください。"]
[]
[null,null,"【別居している場合】遠隔地（別居）開始申請書を別途ご提出ください。"]

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["選択してください",null,"選択してください",null,"選択してください",null,"選択してください",null,"選択してください",null,"選択してください",null,"選択してください",null,"選択してください",null,null,null,null,"・扶養認定日確認資料（写しでの提出可）"]
["5．昭和",null,"1.男",null,"1.夫",null,"1.自宅",null,"1.配偶者の就職",null,"1.被保険者の就職",null,"1.就職",null,"0.なし",null,null,null,null,"※出生の日、または、被保険者の資格取得年月日と同日の場合は不要"]
["7．平成",null,"2.女",null,"2.妻",null,"2.携帯",null,"2.婚姻",null,"2.出生",null,"2.収入増加",null,"1.海外特例要件該当",null,null,null,null,"・結婚による認定",null,null,null,null,null,null,null,null,null,null,"結婚した日がわかる書類（婚姻届の受理証、戸籍謄本等）"]
["9．令和",null,null,null,"3.夫（未届) ",null,"3.勤務先",null,"3.離職",null,"3.離職",null,"3.死亡",null,"2.海外特例要件非該当",null,null,null,null,"・退職による認定",null,null,null,null,null,null,null,null,null,null,"退職日がわかる書類（退職証明書、雇用保険離職票、資格喪失通知書等）"]
[null,null,null,null,"4.妻（未届）",null,"4.その他",null,"4.収入減少",null,"4.収入減少",null,"4.被保険者の離婚",null,null,null,null,null,null,"・雇用形態変更による認定",null,null,null,null,null,null,null,null,null,null,"契約変更後の雇用契約書、または、健康保険資格喪失確認通知書"]
[null,null,null,null,null,null,null,null,"5.その他",null,"5.同居",null,"5.障害認定",null,null,null,null,null,null,"・収入減少による認定",null,null,null,null,null,null,null,null,null,null,"または、被扶養者の勤め先の事業主による証明"]
[null,null,null,null,null,null,null,null,null,null,"6.その他",null,"6.別居",null,null,null,null,null,null,"・雇用保険受給終了による認定",null,null,null,null,null,null,null,null,null,null,"雇用保険受給資格者証（支給終了と印字があるもの）"]
["選択してください",null,"選択してください",null,"選択してください",null,null,null,"選択してください",null,null,null,"7.その他",null,null,null,null,null,null,"・同居開始による認定",null,null,null,null,null,null,null,null,null,null,"世帯全員の住民票"]
["1.同居",null,"1.回収",null,"1.無職",null,null,null,"1.死亡",null,"年","月","日"]
["2.別居",null,"2.返不能",null,"2.パート",null,null,null,"2.離婚"]
[null,null,"3.滅失",null,"3.年金受給者",null,null,null,"3.就職・収入増加",null,null,"　",null,null,null,null,null,null,null,"・扶養削除日確認資料（写しでの提出可）"]
[null,null,null,null,"4.その他",null,null,null,"4.障害認定",null,null,"✓","○","  　○",null,null,null,null,null,"・就職の場合（保険証発行有）",null,null,null,null,null,null,null,null,null,null,"就職先から発行された保険証の写し"]
[null,null,null,null,null,null,null,null,"5.その他",null,null,null,null,null,null,null,null,null,null,"・就職の場合（保険証発行無）",null,null,null,null,null,null,null,null,null,null,"雇用契約書の写し　または　勤務証明書"]
["選択してください",null,null,null,null,null,null,null,null,null,"）",null,null,null,null,null,null,null,null,"・収入増加",null,null,null,null,null,null,null,null,null,null,"勤務証明書"]
["扶養追加",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・死亡",null,null,null,null,null,null,null,null,null,null,"死亡日がわかる書類"]
["扶養削除",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・離婚",null,null,null,null,null,null,null,null,null,null,"離婚届の受理証等"]
["扶養変更"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・収入確認資料（写しでの提出可）"]
["選択してください",null,null,null,"選択してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・学生の場合",null,null,null,null,null,null,null,null,"学生証※高校生の場合、被扶養者異動届の備考欄に高校名を記入することで省略可"]
["1.留学",null,null,null,"1.国内転入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・引き続き収入がない場合",null,null,null,null,null,null,null,null,"最新の非課税証明書"]
["2.同行家族",null,null,null,"2.その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・パート・アルバイトなど",null,null,null,null,null,null,null,null,"直近3ヵ月分の給与明細"]
["3.特定活動",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・自営業の方",null,null,null,null,null,null,null,null,"直近の確定申告書"]
["4.海外婚姻",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・雇用形態変更・収入減少",null,null,null,null,null,null,null,null,"契約書の写し　または　認定日以後3カ月の給与明細"]
["5.その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・年金受給中（障害年金含む）",null,null,null,null,null,null,null,null,"直近の年金額がわかる書類（年金額改定通知書、年金振込通知書等）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・傷病手当金を受給中",null,null,null,null,null,null,null,null,"給付金決定通知書（傷病手当金に関するもの）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・失業給付を受給中",null,null,null,null,null,null,null,null,"雇用保険受給資格者証"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・退職した\n\nまたは、\n現在勤めはないが、\n非課税証明書の中に\n金額の記載がある",null,null,null,null,null,null,null,null,"雇用保険の\n失業給付",null,"受給予定",null,null,null,null,"誓約書+受給開始後、雇用保険受給資格者証"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受給しない",null,null,null,null,"雇用保険被保険者資格喪失確認通知書※離職票交付希望欄が２の場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"雇用保険被保険者離職票-2に公共職業安定所で"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"”法第4条3項不該当（就職意思無し）”証明されているもの"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"延長予定",null,null,null,null,"誓約書+延長手続き後、受給延長通知書"]
[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,"受給資格ない",null,null,null,null,"雇用保険被保険者資格喪失確認通知書等加入期間分かるもの"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"雇用保険に加入なし",null,null,null,null,null,null,"退職時の源泉徴収票、退職時直近の給与明細書等未加入が確認できるもの"]