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[null,null,"厚生年金保険\n事業所番号"]
[null,null,"健康保険\n事業所記号"]
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[null,null,"事業所\n名 　称"]
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[null,null,"被保険者\n整理番号"]
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[null,null,"個人番号"]
[null,null,"喪失年月日",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,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日"]
[null,null,"　　　　喪失原因\n　　　 （不該当）",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,{"$f":"VLOOKUP(Q21,Sheet2!A:N,10,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(入力フォーム!Q21,Sheet2!A:N,11,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q21,Sheet2!A:N,12,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q21,Sheet2!A:N,13,0)","v":0}]
[null,null,"備考",null,null,null,null,null,null,null,null,null,null,null,null,null,"該当するものを選択してください"]
[null,null,"保険証/資格確認書　回収",null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書\nの交付",null,null,null,null,null,null,"選択してください",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,"返不能"]
[null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[null,null,"70歳\n不該当",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者不該当"]
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[]
[null,"被\n保\n険\n者\n2","被保険者\n整理番号"]
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[null,null,"個人番号"]
[null,null,"喪失年月日",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,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日"]
[null,null,"　　　　喪失原因\n　　　 （不該当）",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,{"$f":"VLOOKUP(Q34,Sheet2!A:N,10,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(入力フォーム!Q34,Sheet2!A:N,11,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q34,Sheet2!A:N,12,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q34,Sheet2!A:N,13,0)","v":0}]
[null,null,"備考",null,null,null,null,null,null,null,null,null,null,null,null,null,"該当するものを選択してください"]
[null,null,"保険証/資格確認書　回収",null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書\nの交付",null,null,null,null,null,null,"選択してください",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,"返不能"]
[null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[null,null,"70歳\n不該当",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不該当\n年月日",null,null,null,null,null,null,{"$f":"IF(AE38=\"✓\",\"令和\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE38=\"✓\",\"年\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE38=\"✓\",\"月\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE38=\"✓\",\"日\",\"\")","v":""}]
[]
[null,"被\n保\n険\n者\n3","被保険者\n整理番号"]
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[null,null,"氏名"]
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[null,null,"個人番号"]
[null,null,"喪失年月日",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,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日"]
[null,null,"　　　　喪失原因\n　　　 （不該当）",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,{"$f":"VLOOKUP(Q47,Sheet2!A:N,10,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(入力フォーム!Q47,Sheet2!A:N,11,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q47,Sheet2!A:N,12,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q47,Sheet2!A:N,13,0)","v":0}]
[null,null,"備考",null,null,null,null,null,null,null,null,null,null,null,null,null,"該当するものを選択してください"]
[null,null,"保険証/資格確認書　回収",null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書\nの交付",null,null,null,null,null,null,"選択してください",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,"返不能"]
[null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[null,null,"70歳\n不該当",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不該当\n年月日",null,null,null,null,null,null,{"$f":"IF(AE51=\"✓\",\"令和\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE51=\"✓\",\"年\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE51=\"✓\",\"月\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE51=\"✓\",\"日\",\"\")","v":""}]
[]
[null,"被\n保\n険\n者\n4","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"]
[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,null,"個人番号"]
[null,null,"喪失年月日",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,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日"]
[null,null,"　　　　喪失原因\n　　　 （不該当）",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,{"$f":"VLOOKUP(Q60,Sheet2!A:N,10,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(入力フォーム!Q60,Sheet2!A:N,11,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q60,Sheet2!A:N,12,0)","v":0},null,null,null,null,null,{"$f":"VLOOKUP(Q60,Sheet2!A:N,13,0)","v":0}]
[null,null,"備考",null,null,null,null,null,null,null,null,null,null,null,null,null,"該当するものを選択してください"]
[null,null,"保険証/資格確認書　回収",null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書\nの交付",null,null,null,null,null,null,"選択してください",null,null,null,null,null,"添付",null,null,null,null,null,null,null,null,null,"返不能"]
[null,null,"標準報酬月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[null,null,"70歳\n不該当",null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳以上被用者不該当"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不該当\n年月日",null,null,null,null,null,null,{"$f":"IF(AE64=\"✓\",\"令和\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE64=\"✓\",\"年\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE64=\"✓\",\"月\",\"\")","v":""},null,null,null,null,null,null,null,null,{"$f":"IF(AE64=\"✓\",\"日\",\"\")","v":""}]
[]
[null,"社会保険労務士記載欄"]
[]
[null,"氏　名　等"]

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[null,null,null,null,"健　康　保　険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格喪失届",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生年金保険",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者資格喪失届"]
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[]
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[]
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[]
[null,null,"⑦",null,null,null,null,"該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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の交付",null,null,null,null,null,null,{"$f":"IF(入力フォーム!X62=\"有\",\"〇\",\"\")","v":""},null,null,"・",null,{"$f":"IF(入力フォーム!X62=\"無\",\"〇\",\"\")","v":""},null,null,"※",null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,null,"　　　□　70歳以上被用者不該当\n　　　   　（退職日または死亡日を記入してください）",null,null,"  70歳以上被用者不該当\n    （退職日または死亡日を記入してください）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,"該当する項目を○で囲んでください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"資格確認書等回収",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,"⑧",null,null,null,null,"　　　□　70歳以上被用者不該当\n　　　   　（退職日または死亡日を記入してください）",null,null,"  70歳以上被用者不該当\n    （退職日または死亡日を記入してください）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"入力フォーム!AE64&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"DG129","v":""}]
[null,null,"\n備 考",null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"1. 　二以上事業所勤務者の喪失\",\"○\",\"\")","v":""},null,null,null,"二以上事業所勤務者の喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"2. 　退職後の継続再雇用者の喪失\",\"○\",\"\")","v":""},null,null,null,"退職後の継続再雇用者の喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標 準\n報 酬\n月 額",null,null,null,null,{"$f":"入力フォーム!Q63&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n備 考",null,null,null,null,{"$f":"H130","v":""},null,null,null,"二以上事業所勤務者の喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AO130","v":""},null,null,null,"退職後の継続再雇用者の喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"添付",null,null,null,null,null,{"$f":"CF132","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,"有の場合　資格確認書の回収",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,"70歳\n不該当",null,null,null,null,"不該当\n年月日",null,null,null,null,null," 9. 令和",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"70歳\n不該当",null,null,null,null,"不該当\n年月日",null,null,null,null,null," 9. 令和"]
[null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"3. 　転勤\",\"○\",\"\")","v":""},null,null,null,"転勤",null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"4. 　その他\",\"○\",\"\")","v":""},null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!Q61=\"4. 　その他\",入力フォーム!AP61,\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"添付",null,null,null,null,null,{"$f":"IF(入力フォーム!AH62=\"\",\"\",入力フォーム!AH62)","v":""},null,null,null,null,null,"枚",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力フォーム!AA65=\"\",\"\",入力フォーム!AA65)","v":""},null,{"$f":"IF(入力フォーム!AD65=\"\",\"\",入力フォーム!AD65)","v":""},null,{"$f":"IF(入力フォーム!AJ65=\"\",\"\",入力フォーム!AJ65)","v":""},null,{"$f":"IF(入力フォーム!AM65=\"\",\"\",入力フォーム!AM65)","v":""},null,{"$f":"IF(入力フォーム!AS65=\"\",\"\",入力フォーム!AS65)","v":""},null,{"$f":"IF(入力フォーム!AV65=\"\",\"\",入力フォーム!AV65)","v":""},null,null,null,null,null,null,null,null,null,{"$f":"H132","v":""},null,null,null,"転勤",null,null,null,null,null,null,null,null,{"$f":"U132","v":""},null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AL132","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"DR132","v":""},null,{"$f":"DT132","v":""},null,{"$f":"DV132","v":""},null,{"$f":"DX132","v":""},null,{"$f":"DZ132","v":""},null,{"$f":"EB132","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返不能",null,null,null,null,null,{"$f":"CF134","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,"返不能",null,null,null,null,null,{"$f":"IF(入力フォーム!AR62=\"\",\"\",入力フォーム!AR62)","v":""},null,null,null,null,null,"枚",null,null,null,null,null,null,null,null,null,null,null,"千円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]

{"sheet":"記入方法等","index":2,"n_rows":55,"n_cols":73,"rows_kept":55,"cut":false,"hidden":false,"merged":[[53,1,53,96],[54,1,54,96],[57,1,57,96],[52,1,52,96],[43,1,43,16],[43,18,43,96],[44,1,44,16],[44,18,44,96],[46,1,46,16],[46,18,46,96],[48,1,48,13],[49,1,49,96],[50,1,50,96],[51,1,51,96],[40,1,40,16],[40,18,40,96],[41,1,41,16],[41,18,41,96],[42,1,42,16],[42,18,42,96],[37,1,37,16],[37,18,37,96],[38,1,38,16],[38,18,38,96],[39,1,39,16],[39,18,39,96],[36,1,36,16],[36,18,36,96],[30,17,30,27],[31,17,31,27],[32,17,32,27],[33,17,33,27],[34,1,34,16],[35,1,35,16],[35,18,35,96],[30,28,30,93],[31,28,31,93],[32,28,32,93],[33,28,33,93],[29,1,29,16],[29,18,29,96],[20,1,20,16],[20,18,20,96],[22,21,24,47],[22,48,24,64],[25,21,25,47],[25,48,25,64],[26,21,26,47],[26,48,26,64],[27,21,27,47],[27,48,27,64],[28,1,28,16],[19,1,19,16],[19,18,19,96],[16,1,16,16],[16,21,17,27],[16,28,17,29],[16,30,17,31],[16,32,17,33],[16,34,17,35],[16,36,17,37],[16,38,17,39],[17,1,17,16],[18,1,18,16],[18,18,18,96],[1,1,1,96],[2,1,2,96],[3,1,3,96],[4,1,4,96],[5,1,5,96],[6,1,6,96],[9,1,9,16],[9,18,9,96],[10,64,11,71],[10,72,11,88],[10,34,11,35],[10,36,11,37],[10,38,11,39],[10,40,11,41],[10,61,11,62],[15,1,15,16],[15,18,15,96],[10,42,11,43],[10,46,11,52],[10,53,11,54],[10,55,11,56],[10,57,11,58],[10,59,11,60],[10,21,11,27],[10,32,11,33],[13,1,13,16],[13,18,13,96],[14,1,14,16],[14,18,14,96]]}
[]
[null,"この届書は、「従業員が退職した場合」、「60歳以上の方で退職後に継続して再雇用した場合」、「従業員が死亡した場"]
[null,"合」、「従業員が75歳に到達した場合」、「障害認定を受け後期高齢者医療の資格を取得した場合」等にご提出いただくも"]
[null,"のです。"]
[null,"・70歳以上の方について提出する場合は、「⑧70歳不該当」欄の「□70歳以上被用者不該当」にチェックを入れてください。"]
[null,"・次の場合は日本年金機構宛に別様式での届出をお願いします。"]
[null,"　　従業員等が在職中に70歳に到達した場合→『70歳到達届』（資格喪失届・70歳以上該当届）"]
[]
[null,"記入方法"]
[null,"提出者記入欄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","事業所整理記号・事業所番号は下図を参照し、新規適用時または名称･所在地変更時に付された記号・番号をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事　業　所\n整理記号",null,null,null,null,null,null,null,null,null,null,0,null,1,null,"-",null,"イ",null,"ロ",null,"ハ",null,null,null,"事　業　所\n番　号",null,null,null,null,null,null,1,null,2,null,3,null,4,null,5,null,null,"健康保険\n事業所記号",null,null,null,null,null,null,null,"1　1　1"]
[]
[]
[null,"①被保険者整理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","資格取得時に払い出しされた被保険者整理番号を、必ずご記入ください。"]
[null,"②氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","氏名は住民票に登録されているものと同じ氏名をご記入ください。フリガナはカタカナで正確にご記入ください。"]
[null,"③生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","年号は該当する番号を○で囲んでください。生年月日は下図を参照しご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.昭和\n7.平成",null,null,null,null,null,null,"\n6",null,"\n3",null,"\n0",null,"\n5",null,"\n0",null,"\n3"]
[null,"　"]
[null,"④個人番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","本人確認を行ったうえで、個人番号をご記入ください。基礎年金番号を記入する場合は、年金手帳等に記載されている10桁の"]
[null,"（基礎年金番号）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号を左詰めでご記入ください。ただし、健康保険の届には、記入がなくても構いません。"]
[null,"⑤喪失年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、喪失年月日をご記入ください。　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"西暦2019年5月以降の喪失の場合、９を〇で囲み、（　）内に和暦の元号をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職等による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"退職日の翌日\n転勤の翌日\n雇用契約変更の当日"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　死亡による資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"死亡日の翌日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　75歳到達による健康保険の資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"誕生日の当日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　障害認定による健康保険の資格喪失",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認定日の当日"]
[]
[null,"⑥喪失（不該当）原因",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","下図を参照し、該当する番号を○で囲んでください。退職・死亡の場合は、その当日の年月日を（　）内にご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　4.退職等",null,null,null,null,null,null,null,null,null,null,"　退職した場合、雇用契約の変更等により被保険者の適用対象外となった場合、退職後に継続して再雇用した場合、転勤の場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　5.死亡",null,null,null,null,null,null,null,null,null,null,"　死亡した場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　7.75歳到達",null,null,null,null,null,null,null,null,null,null,"　75歳に到達したことで後期高齢者医療に該当し、健康保険の被保険者資格を喪失する場合"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　9.障害認定",null,null,null,null,null,null,null,null,null,null,"　65歳以上75歳未満の方で、障害認定により後期高齢者医療に該当し、健康保険の被保険者資格を喪失する場合"]
[]
[null,"⑦備考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","「1.二以上事業所勤務者の喪失」は、2カ所以上の適用事業所で勤務している被保険者が喪失する場合に○で囲んでください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"60歳以上の者で、退職した者が1日の空白もなく引き続き再雇用された場合、「2.退職後の継続再雇用者の喪失」を○で囲み、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"この届書とあわせて『被保険者資格取得届』をご提出ください。（取得届には添付資料が必要です。）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"転勤により資格喪失する場合は、「3.転勤」を○で囲み、⑥喪失（不該当）原因　4.退職等に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,null,null,"厚生年金基金の加入員である被保険者であって被保険者の資格を取得した月にその資格を喪失した者については、「3.その他」"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"を○で囲み、（　）内に「加入員の資格同月得喪」とご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「保険証/資格確認書回収」欄は、回収した枚数を「添付」、回収できなかった枚数を「返不能」にご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なお、返不能の場合は、『健康保険　証(書)紛失届』をご提出ください。"]
[null,"⑧70歳不該当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,":","70歳以上の方で資格喪失理由が退職、死亡である場合は、「□70歳以上被用者不該当」にチェックを入れてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"また、「不該当年月日」に退職または死亡した当日の年月日をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"西暦2019年5月以降の不該当の場合、９を〇で囲み、（　）内に和暦の元号をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在職中に70歳に到達された方の厚生年金保険被保険者資格喪失届は、この用紙ではなく『70歳到達届』をご提出ください。"]
[]
[null,"添付書類"]
[null,"　・健康保険被保険者証または資格確認書（本人および被扶養者分）　・健康保険限度額適用認定証　・高齢受給者証　・その他健康保険組合から発行された免除証明書等"]
[null,"　・60歳以上の方で退職後の継続再雇用の場合（資格取得届に添付をお願いします）"]
[null,"　　　　　ア.就業規則・退職辞令のコピー等退職日が確認できる書類および継続して再雇用されたことが確認できる雇用契約書のコピー"]
[null,"　　　　　イ.上記「ア」の書類が添付できない場合、事業主の証明書（退職日、再雇用日が記載され事業主印が押印されているもの）等"]
[null,"　・「⑤喪失年月日」に記入した日付が届書の受付年月日から60日以上さかのぼる場合"]
[null,"　　 退職月の賃金台帳および出勤簿のコピー、株主総会・取締役会等の議事録または役員変更登記の記載がある登記簿謄本のコピー等（役員の場合のみ）"]

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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,"該当するものを選択してください",null,"選択してください"]
["5. 昭和",null,"1. 男",null,"0. 無",null,"0. 　該当なし",null,"0. なし"]
["7. 平成",null,"2. 女",null,"1. 有",null,"1. 　二以上事業所勤務者の喪失",null,"1. 海外在住"]
["9. 令和",null,"3. 坑内員",null,null,null,"2. 　退職後の継続再雇用者の喪失",null,"2. 短期在留"]
[null,null,"5. 男（基金）",null,null,null,"3. 　転勤",null,"3. その他"]
[null,null,"6. 女（基金）",null,null,null,"4. 　その他"]
[null,null,"7. 坑内員（基金）"]
[]
[]
[]
["選択してください",null,null,null,null,"　"]
["4. 　退職等",null,null,null,null,"✓",null,null,null,"令和","年","月","日退職等","日"]
["5. 　死亡",null,null,null,null,null,null,null,null,"令和","年","月","日死亡"]
["7. 　75歳到達（健康保険のみ喪失）"]
["9. 　障害認定（健康保険のみ喪失）"]
["11.社会保障協定"]