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[]
[null,null,"健康保険被扶養者異動(増)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,"【健保組合使用欄】",null,null,null,null,"（2024年12月）",null,null,null,null,null,null,"ア"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"常務理事",null,null,"事務長",null,null,"担当",null,null,null,null,null,"イ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ウ"]
[null,null,"●太枠内を入力・選択(〇・☑)して下さい。入力漏れ・選択漏れがあるものは受付できません。\n●居住区分に応じた「被扶養者届に関する提出書類一覧」(以下「提出書類一覧」)を確認して下さい。",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,"エ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"オ"]
[null,null,"※ 書類は人事企画部へ提出して下さい。（健康保険組合宛てではありませんのでご注意下さい。）"]
[]
[null,null,"被保険者(社員本人)欄","被保険者等\n記号",null,null,null,null,null,null,"被保険者等\n番号",null,null,null,null,null,null,null,null,null,"枝番",null,"社員\nコード"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"00"]
[]
[null,null,null,"氏\n名",null,null,null,null,null,null,null,null,null,null,"生年\n月日",null,"S\nH",null,null,null,null,null,null,null,"居住地","〒"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"昭和"]
[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,false,"平成"]
[null,null,null,"勤務先","（会社名）"]
[]
[null,null,null,null,"（ 所 属 ）",null,null,null,null,null,null,null,null,null,null,null,null,"（ 内 線 ）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL",null,null,null,null,"（",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"昭和"]
[null,null,"被扶養者(家族)欄１","氏\n名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,"生年\n月日",null,"S\nH\nR",null,null,null,null,null,null,null,"性別",null,null,null,null,false,"平成"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"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,"　　　 男\n　　　 女",null,null,null,null,false,"男"]
[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交付希望の有無",null,null,null,null,null,null,"個人番号\n(ﾏｲﾅﾝﾊﾞｰ)",null,null,null,"マイナンバー表記がある\n住民票を添付してください",null,null,null,null,null,null,null,null,null,false,"女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"国内同世帯"]
[null,null,null,"被保険者\nとの\n居住区分",null,null,null,"国内同世帯",null,null,null,"海外居住\n （住民票を除票していない）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がある場合）を参照",null,null,null,null,null,null,"　『提出書類一覧（日本国内に住民票がない場合）』\n　の１ページ目＜ア～オ＞の内、該当するものを選択\n　して下さい。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"国内別世帯"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"海外居住（除票していない）"]
[null,null,null,null,null,null,null,"国内別世帯",null,null,null,"海外居住\n （住民票を除票している）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がない場合）を参照",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"海外居住（除票している）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"出生"]
[null,null,null,"申請理由\n\nおよび\n\n事由発生日",null,null,null,"出生",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,"退職",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　出生日"]
[null,null,null,null,null,null,null,null,null,"　出生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　出生日"]
[null,null,null,null,null,null,null,"結婚",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,"収入の減少",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,null,null,false,"婚姻"]
[null,null,null,null,null,null,null,null,null,"　婚姻日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　発生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　婚姻日"]
[null,null,null,null,null,null,"■","被保険者の入社・再雇用（シニア移行等）に伴う",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　婚姻日"]
[null,null,null,null,null,null,null,null,null,null,"入　 社　 日 ：","Ｒ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"入社日"]
[null,null,null,null,null,null,null,null,null,null,"再 雇 用 日 ：","Ｒ",null,null,null,null,null,null,null,null,null,null,null,null,"　発生日： ",null,"H",null,"R",null,null,null,null,null,null,null,null,null,null,null,null,false,"再雇用日"]
[null,null,null,"被保険者コメント欄（必須項目ではありません。）",null,null,null,null,null,null,null,null,null,null,"事業所担当課コメント欄",null,null,null,null,null,null,null,null,null,null,"【健保組合使用欄】",null,"□","配偶者認定済",null,null,null,null,null,null,null,"登録",null,null,null,null,false,"退職"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　退職日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"証済\n(保）",null,null,null,null,false,"R　退職日"]
[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,"　本　 人 ：",null,null,null,"千円",null,null,null,null,null,null,null,null,null,null,false,"収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　配偶者 ：",null,null,null,"千円",null,null,null,null,null,"証済\n(高）",null,null,null,null,false,"H　収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本人　　　　　配偶者",null,null,null,null,null,"認定年月日",null,null,null,null,null,null,null,null,false,"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,"　被保険者の",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　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,"　2分の1確認 ：  ＯＫ ・ ＮＧ",null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,false,"R　その他"]
[]
[null,null,"被扶養者(家族)欄２","氏\n名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,"生年\n月日",null,"S\nH\nR",null,null,null,null,null,null,null,"性別",null,null,null,null,false,"昭和"]
[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,false,"平成"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　 男\n　　　 女",null,null,null,null,false,"令和"]
[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交付希望の有無",null,null,null,null,null,null,"個人番号\n(ﾏｲﾅﾝﾊﾞｰ)",null,null,null,"マイナンバー表記がある\n住民票を添付してください",null,null,null,null,null,null,null,null,null,false,"男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"女"]
[null,null,null,"被保険者\nとの\n居住区分",null,null,null,"国内同世帯",null,null,null,"海外居住\n （住民票を除票していない）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がある場合）を参照",null,null,null,null,null,null,"　『提出書類一覧（日本国内に住民票がない場合）』\n　の１ページ目＜ア～オ＞の内、該当するものを選択\n　して下さい。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"国内同世帯"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"国内別世帯"]
[null,null,null,null,null,null,null,"国内別世帯",null,null,null,"海外居住\n （住民票を除票している）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がない場合）を参照",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"海外居住（除票していない）"]
[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,false,"海外居住（除票している）"]
[null,null,null,"申請理由\n\nおよび\n\n事由発生日",null,null,null,"出生",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,"退職",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,null,null,false,"出生"]
[null,null,null,null,null,null,null,null,null,"　出生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　出生日"]
[null,null,null,null,null,null,null,"結婚",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,"収入の減少",null,null,null,"H\nR",null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　出生日"]
[null,null,null,null,null,null,null,null,null,"　婚姻日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　発生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"婚姻"]
[null,null,null,null,null,null,"■","被保険者の入社・再雇用（シニア移行等）に伴う",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　婚姻日"]
[null,null,null,null,null,null,null,null,null,null,"入　 社　 日 ：","Ｒ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　婚姻日"]
[null,null,null,null,null,null,null,null,null,null,"再 雇 用 日 ：","Ｒ",null,null,null,null,null,null,null,null,null,null,null,null,"　発生日： ",null,"H",null,"R",null,null,null,null,null,null,null,null,null,null,null,null,false,"入社日"]
[null,null,null,"被保険者コメント欄（必須項目ではありません。）",null,null,null,null,null,null,null,null,null,null,"事業所担当課コメント欄",null,null,null,null,null,null,null,null,null,null,"【健保組合使用欄】",null,"□","配偶者認定済",null,null,null,null,null,null,null,"登録",null,null,null,null,false,"再雇用日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"退職"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"証済\n(保）",null,null,null,null,false,"H　退職日"]
[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,"　本　 人 ：",null,null,null,"千円",null,null,null,null,null,null,null,null,null,null,false,"R　退職日"]
[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,"　配偶者 ：",null,null,null,"千円",null,null,null,null,null,"証済\n(高）",null,null,null,null,false,"収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本人　　　　　配偶者",null,null,null,null,null,"認定年月日",null,null,null,null,null,null,null,null,false,"R　収入の減少"]
[null,null,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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"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,"　2分の1確認 ：  ＯＫ ・ ＮＧ",null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,false,"H　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,false,"R　その他"]
[null,null,"最終チェック",null,null,null,null,null,null,null,"この届出は申請する被保険者（社員本人）が作成しました。"]
[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,"受　付　印"]
[]
[null,null,"　事業所所在地\n　事業所名称\n　事業主氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"チェックⅠ"]
[]
[]
[]
[]
[]
[]
[null,null,"健康保険被扶養者異動(増)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,{"$f":"AI2","v":"（2024年12月）"}]
[]
[]
[null,null," ●太枠内を入力・選択(〇・☑)して下さい。入力漏れ・選択漏れがあるものは受付できません。\n ●居住区分に応じた「被扶養者届に関する提出書類一覧」(以下「提出書類一覧」)を確認して下さい。\n ●最後に「最終チェック」欄を必ず確認の上、チェック（☑）して下さい。"]
[]
[]
[]
[null,null,"被保険者(社員本人)欄","被保険者等\n記号",null,null,{"$f":"IF(G9=\"\",\"\",G9)","v":""},null,null,null,"被保険者等\n番号\n",null,null,{"$f":"IF(N9=\"\",\"\",N9)","v":""},null,null,null,null,null,null,"枝番",null,"社員\nコード",null,null,{"$f":"IF(Z9=\"\",\"\",Z9)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"00"]
[]
[null,null,null,"氏\n名",{"$f":"IF(E12=\"\",\"\",E12)","v":""},null,null,null,null,{"$f":"IF(J12=\"\",\"\",J12)","v":""},null,null,null,null,"生年\n月日",null,"S\nH",null,{"$f":"IF(S12=\"\",\"\",S12)","v":""},null,{"$f":"IF(U12=\"\",\"\",U12)","v":""},null,{"$f":"IF(W12=\"\",\"\",W12)","v":""},null,"居住地","〒",{"$f":"IF(AA12=\"\",\"\",AA12)","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,{"$f":"IF(Z13=\"\",\"\",Z13)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AP13","v":false},"昭和"]
[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,{"$f":"AP14","v":false},"平成"]
[null,null,null,"勤務先","（会社名）",null,{"$f":"IF(G15=\"\",\"\",G15)","v":""}]
[]
[null,null,null,null,"（ 所 属 ）",null,{"$f":"IF(G17=\"\",\"\",G17)","v":""},null,null,null,null,null,null,null,null,null,null,"（ 内 線 ）",null,{"$f":"IF(T17=\"\",\"\",T17)","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,"TEL",null,{"$f":"IF(AA18=\"\",\"\",AA18)","v":""},null,null,"（",{"$f":"IF(AE18=\"\",\"\",AE18)","v":""},null,null,"）",{"$f":"IF(AI18=\"\",\"\",AI18)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AP19","v":false},"昭和"]
[null,null,"被扶養者(家族)欄１","氏\n名",{"$f":"IF(E20=\"\",\"\",E20)","v":""},null,null,null,null,null,null,null,{"$f":"IF(M20=\"\",\"\",M20)","v":""},null,null,null,null,null,null,null,"続柄",null,{"$f":"IF(W20=\"\",\"\",W20)","v":""},null,null,null,"生年\n月日",null,"S\nH\nR",null,{"$f":"IF(AE20=\"\",\"\",AE20)","v":""},null,{"$f":"IF(AG20=\"\",\"\",AG20)","v":""},null,{"$f":"IF(AI20=\"\",\"\",AI20)","v":""},null,"性別",null,null,null,null,false,"平成"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"令和"]
[null,null,null,null,{"$f":"IF(E22=\"\",\"\",E22)","v":""},null,null,null,null,null,null,null,{"$f":"IF(M22=\"\",\"\",M22)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　 男\n　　　 女",null,null,null,null,false,"男"]
[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交付希望の有無",null,null,null,{"$f":"IF(Y23=\"\",\"\",Y23)","v":""},null,null,"個人番号\n(ﾏｲﾅﾝﾊﾞｰ)",null,null,null,"マイナンバー表記がある\n住民票を添付してください",null,null,null,null,null,null,null,null,null,false,"女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"国内同世帯"]
[null,null,null,"被保険者との\n居住区分",null,null,null,"国内同世帯",null,null,null,"海外居住\n （住民票を除票していない）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がある場合）を参照",null,null,null,null,null,null,"　『提出書類一覧（日本国内に住民票がない場合）』\n　の１ページ目＜ア～オ＞の内、該当するものを選択\n　して下さい。",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AK25=\"\",\"\",AK25)","v":""},null,null,null,null,false,"国内別世帯"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"海外居住（除票していない）"]
[null,null,null,null,null,null,null,"国内別世帯",null,null,null,"海外居住\n （住民票を除票している）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がない場合）を参照",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"海外居住（除票している）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"出生"]
[null,null,null,"申請理由\n\nおよび\n\n事由発生日",null,null,null,"出生",null,null,null,"H\nR",{"$f":"IF(M29=\"\",\"\",M29)","v":""},null,null,null,{"$f":"IF(Q29=\"\",\"\",Q29)","v":""},null,null,{"$f":"IF(T29=\"\",\"\",T29)","v":""},null,null,null,"退職",null,null,null,"H\nR",{"$f":"IF(AC29=\"\",\"\",AC29)","v":""},null,null,null,{"$f":"IF(AG29=\"\",\"\",AG29)","v":""},null,null,{"$f":"IF(AJ29=\"\",\"\",AJ29)","v":""},null,null,null,null,null,false,"H　出生日"]
[null,null,null,null,null,null,null,null,null,"　出生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　出生日"]
[null,null,null,null,null,null,null,"結婚",null,null,null,"H\nR",{"$f":"IF(M31=\"\",\"\",M31)","v":""},null,null,null,{"$f":"IF(Q31=\"\",\"\",Q31)","v":""},null,null,{"$f":"IF(T31=\"\",\"\",T31)","v":""},null,null,null,"収入の減少",null,null,null,"H\nR",{"$f":"IF(AC31=\"\",\"\",AC31)","v":""},null,null,null,{"$f":"IF(AG31=\"\",\"\",AG31)","v":""},null,null,{"$f":"IF(AJ31=\"\",\"\",AJ31)","v":""},null,null,null,null,null,false,"婚姻"]
[null,null,null,null,null,null,null,null,null,"　婚姻日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　発生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　婚姻日"]
[null,null,null,null,null,null,"■","被保険者の入社・再雇用（シニア移行等）に伴う",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,{"$f":"IF(Z33=\"\",\"\",Z33)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　婚姻日"]
[null,null,null,null,null,null,null,null,null,null,"入　 社　 日 ：","Ｒ",{"$f":"IF(M34=\"\",\"\",M34)","v":""},null,null,null,{"$f":"IF(Q34=\"\",\"\",Q34)","v":""},null,null,{"$f":"IF(T34=\"\",\"\",T34)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"入社日"]
[null,null,null,null,null,null,null,null,null,null,"再 雇 用 日 ：","Ｒ",{"$f":"IF(M35=\"\",\"\",M35)","v":""},null,null,null,{"$f":"IF(Q35=\"\",\"\",Q35)","v":""},null,null,{"$f":"IF(T35=\"\",\"\",T35)","v":""},null,null,null,null,"　発生日： ",null,"H",null,"R",{"$f":"IF(AD35=\"\",\"\",AD35)","v":""},null,null,{"$f":"IF(AG35=\"\",\"\",AG35)","v":""},null,null,{"$f":"IF(AJ35=\"\",\"\",AJ35)","v":""},null,null,null,null,null,false,"再雇用日"]
[null,null,null,"被保険者コメント欄（必須項目ではありません。）",null,null,null,null,null,null,null,null,null,null,"事業所担当課コメント欄",null,null,null,null,null,null,null,null,null,null,"【健保組合使用欄】",null,"□","配偶者認定済",null,null,null,null,null,null,null,"登録",null,null,null,null,false,"退職"]
[null,null,null,{"$f":"IF(D37=\"\",\"\",D37)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　退職日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"証済\n(保）",null,null,null,null,false,"R　退職日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　本　 人 ：",null,null,null,"千円",null,null,null,null,null,null,null,null,null,null,false,"収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　配偶者 ：",null,null,null,"千円",null,null,null,null,null,"証済\n(高）",null,null,null,null,false,"H　収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本人　　　　　配偶者",null,null,null,null,null,"認定年月日",null,null,null,null,null,null,null,null,false,"その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　被保険者の",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　その他"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　2分の1確認 ：  ＯＫ ・ ＮＧ",null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,false,"R　その他"]
[]
[null,null,"被扶養者(家族)欄２","氏\n名",{"$f":"IF(E46=\"\",\"\",E46)","v":""},null,null,null,null,null,null,null,{"$f":"IF(M46=\"\",\"\",M46)","v":""},null,null,null,null,null,null,null,"続柄",null,{"$f":"IF(W46=\"\",\"\",W46)","v":""},null,null,null,"生年\n月日",null,"S\nH\nR",null,{"$f":"IF(AE46=\"\",\"\",AE46)","v":""},null,{"$f":"IF(AG46=\"\",\"\",AG46)","v":""},null,{"$f":"IF(AI46=\"\",\"\",AI46)","v":""},null,"性別",null,null,null,null,{"$f":"AP46","v":false},"昭和"]
[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,false,"平成"]
[null,null,null,null,{"$f":"IF(E48=\"\",\"\",E48)","v":""},null,null,null,null,null,null,null,{"$f":"IF(M48=\"\",\"\",M48)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　 男\n　　　 女",null,null,null,null,false,"令和"]
[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交付希望の有無",null,null,null,{"$f":"IF(Y49=\"\",\"\",Y49)","v":""},null,null,"個人番号\n(ﾏｲﾅﾝﾊﾞｰ)",null,null,null,"マイナンバー表記がある\n住民票を添付してください",null,null,null,null,null,null,null,null,null,false,"男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"女"]
[null,null,null,"被保険者との\n居住区分",null,null,null,"国内同世帯",null,null,null,"海外居住\n （住民票を除票していない）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がある場合）を参照",null,null,null,null,null,null,"　『提出書類一覧（日本国内に住民票がない場合）』\n　の１ページ目＜ア～オ＞の内、該当するものを選択\n　して下さい。",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AK51=\"\",\"\",AK51)","v":""},null,null,null,null,false,"国内同世帯"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"国内別世帯"]
[null,null,null,null,null,null,null,"国内別世帯",null,null,null,"海外居住\n （住民票を除票している）",null,null,null,null,null,null," 提出書類一覧（日本国内に\n 住民票がない場合）を参照",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"海外居住（除票していない）"]
[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,false,"海外居住（除票している）"]
[null,null,null,"申請理由\n\nおよび\n\n事由発生日",null,null,null,"出生",null,null,null,"H\nR",{"$f":"IF(M55=\"\",\"\",M55)","v":""},null,null,null,{"$f":"IF(Q55=\"\",\"\",Q55)","v":""},null,null,{"$f":"IF(T55=\"\",\"\",T55)","v":""},null,null,null,"退職",null,null,null,"H\nR",{"$f":"IF(AC55=\"\",\"\",AC55)","v":""},null,null,null,{"$f":"IF(AG55=\"\",\"\",AG55)","v":""},null,null,{"$f":"IF(AJ55=\"\",\"\",AJ55)","v":""},null,null,null,null,null,false,"出生"]
[null,null,null,null,null,null,null,null,null,"　出生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　退職日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　出生日"]
[null,null,null,null,null,null,null,"結婚",null,null,null,"H\nR",{"$f":"IF(M57=\"\",\"\",M57)","v":""},null,null,null,{"$f":"IF(Q57=\"\",\"\",Q57)","v":""},null,null,{"$f":"IF(T57=\"\",\"\",T57)","v":""},null,null,null,"収入の減少",null,null,null,"H\nR",{"$f":"IF(AC57=\"\",\"\",AC57)","v":""},null,null,null,{"$f":"IF(AG57=\"\",\"\",AG57)","v":""},null,null,{"$f":"IF(AJ57=\"\",\"\",AJ57)","v":""},null,null,null,null,null,false,"R　出生日"]
[null,null,null,null,null,null,null,null,null,"　婚姻日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　発生日： ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"婚姻"]
[null,null,null,null,null,null,"■","被保険者の入社・再雇用（シニア移行等）に伴う",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,{"$f":"IF(Z59=\"\",\"\",Z59)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　婚姻日"]
[null,null,null,null,null,null,null,null,null,null,"入　 社　 日 ：","Ｒ",{"$f":"IF(M60=\"\",\"\",M60)","v":""},null,null,null,{"$f":"IF(Q60=\"\",\"\",Q60)","v":""},null,null,{"$f":"IF(T60=\"\",\"\",T60)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R　婚姻日"]
[null,null,null,null,null,null,null,null,null,null,"再 雇 用 日 ：","Ｒ",{"$f":"IF(M61=\"\",\"\",M61)","v":""},null,null,null,{"$f":"IF(Q61=\"\",\"\",Q61)","v":""},null,null,{"$f":"IF(T61=\"\",\"\",T61)","v":""},null,null,null,null,"　発生日： ",null,"H",null,"R",{"$f":"IF(AD61=\"\",\"\",AD61)","v":""},null,null,{"$f":"IF(AG61=\"\",\"\",AG61)","v":""},null,null,{"$f":"IF(AJ61=\"\",\"\",AJ61)","v":""},null,null,null,null,null,false,"入社日"]
[null,null,null,"被保険者コメント欄（必須項目ではありません。）",null,null,null,null,null,null,null,null,null,null,"事業所担当課コメント欄",null,null,null,null,null,null,null,null,null,null,"【健保組合使用欄】",null,"□","配偶者認定済",null,null,null,null,null,null,null,"登録",null,null,null,null,false,"再雇用日"]
[null,null,null,{"$f":"IF(D63=\"\",\"\",D63)","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,false,"退職"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"証済\n(保）",null,null,null,null,false,"H　退職日"]
[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,"　本　 人 ：",null,null,null,"千円",null,null,null,null,null,null,null,null,null,null,false,"R　退職日"]
[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,"　配偶者 ：",null,null,null,"千円",null,null,null,null,null,"証済\n(高）",null,null,null,null,false,"収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H　収入の減少"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本人　　　　　配偶者",null,null,null,null,null,"認定年月日",null,null,null,null,null,null,null,null,false,"R　収入の減少"]
[null,null,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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"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,"　2分の1確認 ：  ＯＫ ・ ＮＧ",null,null,null,null,null,null,"年",null,"月",null,"日",null,null,null,false,"H　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,false,"R　その他"]
[null,null,"最終チェック",null,null,null,null,null,null,null,"この届出は申請する被保険者（社員本人）が作成しました。"]
[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,"確　認　印",null,null,null,null,null,null,null,null,{"$f":"AP75","v":false},"チェックⅠ"]
[]
[null,null,"　事業所所在地\n　事業所名称\n　事業主氏名"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"書類受理日　※健保組合使用欄"]

{"sheet":"注意事項","index":1,"n_rows":8,"n_cols":7,"rows_kept":8,"cut":false,"hidden":false,"merged":[]}
[]
[null,null,"◆"]
[null,null,null,"↑このメッセージが出たら、必ずコンテンツを有効化して下さい。"]
[]
[null,null,"◆",null,null,null,"の部分に漏れなく入力・チェック（☑）して下さい。（［副］は入力不要です。）"]
[null,null,"◆","１枚に家族２名まで入力できます。"]
[null,null,"◆","最後に 『最終チェック』 欄を確認のうえ、必ずチェック（☑）して下さい。"]
[null,null,"◆","正・副2枚を所属事業所の人事部門に提出して下さい。"]