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[]
[null,"健康保険被扶養者異動(減)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,"【健保組合使用欄】",null,null,null,null,"（2021年10月）"]
[null,null,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,"■","太枠内を全て記入・選択(〇・☑)して下さい。"]
[null,"■","入力・選択漏れがあるものは受付できません。"]
[null,"■","最後に「最終チェック」欄を必ず確認の上、☑ して下さい。"]
[null,"■","該当被扶養者(家族)に発行されている被保険者証、高齢受給者証、限度額適用認定証は全て回収となりますので、必ず添付して下さい。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　【申請ルート】　社員本人 ⇒ 所属事業所の人事部門"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※健保組合ではありませんのでご注意下さい。"]
[]
[null,"被保険者(社員本人)欄","被保険者証\n記号",null,null,null,null,null,null,"被保険者証\n番号",null,null,null,null,null,null,null,null,null,"社員コード"]
[]
[null,null,"氏名",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,false,"S"]
[null,null,"勤務先","（会社名）",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,false,"H"]
[null,null,null,"（所属）",null,null,null,null,null,null,null,null,null,"（内 線）",null,null,null,null,null,null,null,null,null,"TEL",null,null,null,"（",null,null,null,"）"]
[]
[null,"被扶養者(家族)欄１","氏名",null,null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,"性別",null,null,"男\n女","生年\n月日",null,null,"S",null,null,null,null,null,null,null,null,false,"男",null,false,"収入増"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H",null,null,null,null,null,null,null,null,false,"女",null,false,"H（収入増）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"R",null,null,null,null,null,null,null,null,false,"S",null,false,"R（収入増）"]
[null,null,"申請事由\n\nおよび\n\n事由発生日",null,null,"■","他の社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,null,"収入の増加",null,null,"（",null,null,null,null,"円／年）",null,"【健保組合使用欄】",null,null,null,null,null,null,null,false,"H",null,false,"離婚"]
[null,null,null,null,null,null,null,"就職またはパート先等で社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,"　 事由",null,"H","R",null,null,null,null,null,null,"資格喪失証明書発行",null,null,null,null,null,null,null,false,"R",null,false,"H（離婚）"]
[null,null,null,null,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,null,null,false,"社保加入",null,false,"R（離婚）"]
[null,null,null,null,null,null,null,"他の家族の扶養家族になった",null,null,null,null,null,null,null,null,null,null,null,"離婚",null,null,null,null,null,null,null,null,null,"有　・　無",null,null,null,null,null,null,null,false,"扶養異動",null,false,"死亡"]
[null,null,null,null,null,null,"　加入日：",null,"H","R",null,null,null,null,null,null,null,null,null,null,"離婚日：","H","R",null,null,null,null,null,null,null,null,null,null,null,"登録",null,null,false,"H（社保加入）",null,false,"H（死亡）"]
[null,null,null,null,null,null,"結婚",null,null,null,null,null,null,null,null,null,null,null,null,"死亡",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"再",null,null,false,"R（社保加入）",null,false,"R（死亡）"]
[null,null,null,null,null,null,null,"　婚姻日：","H","R",null,null,null,null,null,null,null,null,null,null,"　死亡日：","H","R",null,null,null,null,null,null,null,null,null,null,null,"再",null,null,false,"結婚",null,false,"その他"]
[null,null,null,null,null,null,"被保険者と別世帯（国内）",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,"滅失届",null,null,null,false,"H（結婚）",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,false,"R（結婚）",null,false,"R（その他）"]
[null,null,null,null,null,null,"世帯を　",null,"H","R",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療費精算",null,null,null,"有 ・ 無",null,null,null,false,"別世帯",null,false,"添付しました"]
[null,null,null,null,null,null,"分けた日：",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,null,false,"H（別世帯）",null,false,"添付できません"]
[null,null,null,null,null,null,"海外居住",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健診費精算",null,null,null,"有 ・ 無",null,null,null,false,"R（別世帯）",null,false,"紛失"]
[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,false,"海外居住",null,false,"その他（添付できません）"]
[null,null,null,null,null,null,"　 事由",null,"H","R",null,null,null,null,null,null,null,null,null,"　 事由",null,"H","R",null,null,null,null,null,null,"新証写添付",null,null,null,"有 ・ 無",null,null,null,false,"H（海外居住）"]
[null,null,null,null,null,null,"発生日：",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,null,null,false,"R（海外居住"]
[null,null,"被保険者証\n回収状況\n（該当者分）",null,null,null,"添付しました",null,null,null,null,null,null,"紛失　⇒",null,"「健康保険被保険者証滅失届」を添付して下さい。",null,null,null,null,null,null,null,null,null,null,null,null,null,"削除年月日"]
[null,null,null,null,null,null,"添付できません",null,null,null,null,null,null,"その他 ⇒ 理由（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null," ※添付できない理由",null,null,null,null,null,null,null,null," 回収時期 （R",null,null,null,null,null,null,null,null,null,"頃）",null,null,null,null,"年",null,"月",null,"日"]
[]
[null,"被扶養者(家族)欄２","氏名",null,null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,"性別",null,null,"男\n女","生年\n月日",null,null,"S",null,null,null,null,null,null,null,null,false,"男",null,false,"収入増"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H",null,null,null,null,null,null,null,null,false,"女",null,false,"H（収入増）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"R",null,null,null,null,null,null,null,null,false,"S",null,false,"R（収入増）"]
[null,null,"申請事由\n\nおよび\n\n事由発生日",null,null,"■","他の社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,null,"収入の増加",null,null,"（",null,null,null,null,"円／年）",null,"【健保組合使用欄】",null,null,null,null,null,null,null,false,"H",null,false,"離婚"]
[null,null,null,null,null,null,null,"就職またはパート先等で社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,"　 事由",null,"H","R",null,null,null,null,null,null,"資格喪失証明書発行",null,null,null,null,null,null,null,false,"R",null,false,"H（離婚）"]
[null,null,null,null,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,null,null,false,"社保加入",null,false,"R（離婚）"]
[null,null,null,null,null,null,null,"他の家族の扶養家族になった",null,null,null,null,null,null,null,null,null,null,null,"離婚",null,null,null,null,null,null,null,null,null,"有　・　無",null,null,null,null,null,null,null,false,"扶養異動",null,false,"死亡"]
[null,null,null,null,null,null,"　加入日：",null,"H","R",null,null,null,null,null,null,null,null,null,null,"離婚日：","H","R",null,null,null,null,null,null,null,null,null,null,null,"登録",null,null,false,"H（社保加入）",null,false,"H（死亡）"]
[null,null,null,null,null,null,"結婚",null,null,null,null,null,null,null,null,null,null,null,null,"死亡",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"再",null,null,false,"R（社保加入）",null,false,"R（死亡）"]
[null,null,null,null,null,null,null,"　婚姻日：","H","R",null,null,null,null,null,null,null,null,null,null,"　死亡日：","H","R",null,null,null,null,null,null,null,null,null,null,null,"再",null,null,false,"結婚",null,false,"その他"]
[null,null,null,null,null,null,"被保険者と別世帯（国内）",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,"滅失届",null,null,null,false,"H（結婚）",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,false,"R（結婚）",null,false,"R（その他）"]
[null,null,null,null,null,null,"世帯を　",null,"H","R",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療費精算",null,null,null,"有 ・ 無",null,null,null,false,"別世帯",null,false,"添付しました"]
[null,null,null,null,null,null,"分けた日：",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,null,false,"H（別世帯）",null,false,"添付できません"]
[null,null,null,null,null,null,"海外居住",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健診費精算",null,null,null,"有 ・ 無",null,null,null,false,"R（別世帯）",null,false,"紛失"]
[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,false,"海外居住",null,false,"その他（添付できません）"]
[null,null,null,null,null,null,"　 事由",null,"H","R",null,null,null,null,null,null,null,null,null,"　 事由",null,"H","R",null,null,null,null,null,null,"新証写添付",null,null,null,"有 ・ 無",null,null,null,false,"H（海外居住）"]
[null,null,null,null,null,null,"発生日：",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,null,null,false,"R（海外居住"]
[null,null,"被保険者証\n回収状況\n（該当者分）",null,null,null,"添付しました",null,null,null,null,null,null,"紛失　⇒",null,"「健康保険被保険者証滅失届」を添付して下さい。",null,null,null,null,null,null,null,null,null,null,null,null,null,"削除年月日"]
[null,null,null,null,null,null,"添付できません",null,null,null,null,null,null,"その他 ⇒ 理由（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null," ※添付できない理由",null,null,null,null,null,null,null,null," 回収時期 （R",null,null,null,null,null,null,null,null,null,"頃）",null,null,null,null,"年",null,"月",null,"日"]
[]
[null,"最終チェック",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,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,null,false,"被保険者作成"]
[]
[]
[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,"事業所所在地\n事業所名称\n事業主氏名"]
[]
[]
[]
[null,"健康保険被扶養者異動(減)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,{"$f":"AF2","v":"（2021年10月）"}]
[]
[]
[null,"■","太枠内を全て記入・選択(〇・☑)して下さい。"]
[null,"■","入力・選択漏れがあるものは受付できません。"]
[null,"■","最後に「最終チェック」欄を必ず確認の上、☑ して下さい。"]
[null,"■","該当被扶養者(家族)に発行されている被保険者証、高齢受給者証、限度額適用認定証は全て回収となりますので、必ず添付して下さい。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　【申請ルート】　社員本人 ⇒ 所属事業所の人事部門"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※健保組合ではありませんのでご注意下さい。"]
[]
[null,"被保険者(社員本人)欄","被保険者証\n記号",null,null,{"$f":"IF(F12=\"\",\"\",F12)","v":""},null,null,null,"被保険者証\n番号",null,null,{"$f":"IF(M12=\"\",\"\",M12)","v":""},null,null,null,null,null,null,"社員コード",null,null,{"$f":"IF(W12=\"\",\"\",W12)","v":""}]
[]
[null,null,"氏名",{"$f":"IF(D14=\"\",\"\",D14)","v":""},null,null,null,null,{"$f":"IF(I14=\"\",\"\",I14)","v":""},null,null,null,null,"生年\n月日",null,"S\nH",null,{"$f":"IF(R14=\"\",\"\",R14)","v":""},null,{"$f":"IF(T14=\"\",\"\",T14)","v":""},null,{"$f":"IF(V14=\"\",\"\",V14)","v":""},null,"居住地","〒",{"$f":"IF(Z14=\"\",\"\",Z14)","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,{"$f":"IF(Y15=\"\",\"\",Y15)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AL15","v":false},"S"]
[null,null,"勤務先","（会社名）",null,{"$f":"IF(F16=\"\",\"\",F16)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AL16","v":false},"H"]
[null,null,null,"（所 　属）",null,{"$f":"IF(F17=\"\",\"\",F17)","v":""},null,null,null,null,null,null,null,"（内　 線）",null,{"$f":"IF(P17=\"\",\"\",P17)","v":""},null,null,null,null,null,null,null,"TEL",{"$f":"IF(Y17=\"\",\"\",Y17)","v":""},null,null,"（",{"$f":"IF(AC17=\"\",\"\",AC17)","v":""},null,null,"）",{"$f":"IF(AG17=\"\",\"\",AG17)","v":""}]
[]
[null,"被扶養者(家族)欄１","氏名",{"$f":"IF(D19=\"\",\"\",D19)","v":""},null,null,null,null,null,{"$f":"IF(J19=\"\",\"\",J19)","v":""},null,null,null,null,null,"続柄",null,null,{"$f":"IF(S19=\"\",\"\",S19)","v":""},null,null,"性別",null,null,"男\n女","生年\n月日",null,null,"S",{"$f":"IF(AD19=\"\",\"\",AD19)","v":""},null,{"$f":"IF(AF19=\"\",\"\",AF19)","v":""},null,{"$f":"IF(AH19=\"\",\"\",AH19)","v":""},null,null,null,{"$f":"AL19","v":false},"男",null,false,"収入増"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H",null,null,null,null,null,null,null,null,false,"女",null,{"$f":"AO20","v":false},"H（収入増）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"R",null,null,null,null,null,null,null,null,false,"S",null,false,"R（収入増）"]
[null,null,"申請事由\n\nおよび\n\n事由発生日",null,null,"■","他の社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,null,"収入の増加 ",null,null,"（",{"$f":"IF(X22=\"\",\"\",X22)","v":""},null,null,null,"円／年）",null,"【健保組合使用欄】",null,null,null,null,null,null,null,false,"H",null,false,"離婚"]
[null,null,null,null,null,null,null,"就職またはパート先等で社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,"　 事由",null,"H","R",{"$f":"IF(X23=\"\",\"\",X23)","v":""},null,{"$f":"IF(Z23=\"\",\"\",Z23)","v":""},null,{"$f":"IF(AB23=\"\",\"\",AB23)","v":""},null,"資格喪失証明書発行",null,null,null,null,null,null,null,false,"R",null,false,"H（離婚）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"発生日：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"社保加入",null,false,"R（離婚）"]
[null,null,null,null,null,null,null,"他の家族の扶養家族になった",null,null,null,null,null,null,null,null,null,null,null,"離婚",null,null,null,null,null,null,null,null,null,"有　・　無",null,null,null,null,null,null,null,false,"扶養異動",null,false,"死亡"]
[null,null,null,null,null,null,"　加入日：",null,"H","R",{"$f":"IF(K26=\"\",\"\",K26)","v":""},null,{"$f":"IF(M26=\"\",\"\",M26)","v":""},null,{"$f":"IF(O26=\"\",\"\",O26)","v":""},null,null,null,null,null,"離婚日：","H","R",{"$f":"IF(X26=\"\",\"\",X26)","v":""},null,{"$f":"IF(Z26=\"\",\"\",Z26)","v":""},null,{"$f":"IF(AB26=\"\",\"\",AB26)","v":""},null,null,null,null,null,null,"登録",null,null,false,"H（社保加入）",null,false,"H（死亡）"]
[null,null,null,null,null,null,"結婚",null,null,null,null,null,null,null,null,null,null,null,null,"死亡",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"再",null,null,false,"R（社保加入）",null,false,"R（死亡）"]
[null,null,null,null,null,null,null,"　婚姻日：","H","R",{"$f":"IF(K28=\"\",\"\",K28)","v":""},null,{"$f":"IF(M28=\"\",\"\",M28)","v":""},null,{"$f":"IF(O28=\"\",\"\",O28)","v":""},null,null,null,null,null,"　死亡日：","H","R",{"$f":"IF(X28=\"\",\"\",X28)","v":""},null,{"$f":"IF(Z28=\"\",\"\",Z28)","v":""},null,{"$f":"IF(AB28=\"\",\"\",AB28)","v":""},null,null,null,null,null,null,"再",null,null,false,"結婚",null,false,"その他"]
[null,null,null,null,null,null,"被保険者と別世帯（国内）",null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,"滅失届",null,null,null,false,"H（結婚）",null,false,"H（その他）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R（結婚）",null,false,"R（その他）"]
[null,null,null,null,null,null,"世帯を　",null,"H","R",{"$f":"IF(K31=\"\",\"\",K31)","v":""},null,{"$f":"IF(M31=\"\",\"\",M31)","v":""},null,{"$f":"IF(O31=\"\",\"\",O31)","v":""},null,null,null,null,null,{"$f":"IF(U31=\"\",\"\",U31)","v":""},null,null,null,null,null,null,null,null,"医療費精算",null,null,null,"有 ・ 無",null,null,null,false,"別世帯",null,false,"添付しました"]
[null,null,null,null,null,"分けた日：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H（別世帯）",null,false,"添付できません"]
[null,null,null,null,null,null,"海外居住",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健診費精算",null,null,null,"有 ・ 無",null,null,null,false,"R（別世帯）",null,false,"紛失"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AL34","v":false},"海外居住",null,false,"その他（添付できません）"]
[null,null,null,null,null,null,"　 事由",null,"H","R",{"$f":"IF(K35=\"\",\"\",K35)","v":""},null,{"$f":"IF(M35=\"\",\"\",M35)","v":""},null,{"$f":"IF(O35=\"\",\"\",O35)","v":""},null,null,null,null,"　 事由",null,"H","R",{"$f":"IF(T39=\"\",\"\",T39)","v":""},null,{"$f":"IF(Z35=\"\",\"\",Z35)","v":""},null,{"$f":"IF(AB35=\"\",\"\",AB35)","v":""},null,"新証写添付",null,null,null,"有 ・ 無",null,null,null,false,"H（海外居住）"]
[null,null,null,null,null,null,"発生日：",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,null,null,false,"R（海外居住"]
[null,null,"被保険者証\n回収状況\n（該当者分）",null,null,null,"添付しました",null,null,null,null,null,null,"紛失　⇒",null,"「健康保険被保険者証滅失届」を添付して下さい。",null,null,null,null,null,null,null,null,null,null,null,null,null,"削除年月日"]
[null,null,null,null,null,null,"添付できません",null,null,null,null,null,null,"その他 ⇒ 理由（",null,null,null,{"$f":"IF(R38=\"\",\"\",R38)","v":""},null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null," ※添付できない理由",null,null,null,null,null,null,null,null," 回収時期 （R",null,null,null,{"$f":"IF(T39=\"\",\"\",T39)","v":""},null,{"$f":"IF(V39=\"\",\"\",V39)","v":""},null,{"$f":"IF(X39=\"\",\"\",X39)","v":""},null,"頃）",null,null,null,null,"年",null,"月",null,"日"]
[]
[null,"被扶養者(家族)欄２","氏名",{"$f":"IF(D41=\"\",\"\",D41)","v":""},null,null,null,null,null,{"$f":"IF(J41=\"\",\"\",J41)","v":""},null,null,null,null,null,"続柄",null,null,{"$f":"IF(S41=\"\",\"\",S41)","v":""},null,null,"性別",null,null,"男\n女","生年\n月日",null,null,"S",{"$f":"IF(AD41=\"\",\"\",AD41)","v":""},null,{"$f":"IF(AF41=\"\",\"\",AF41)","v":""},null,{"$f":"IF(AH41=\"\",\"\",AH41)","v":""},null,null,null,{"$f":"AL41","v":false},"男",null,false,"収入増"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H",null,null,null,null,null,null,null,null,{"$f":"AL42","v":false},"女",null,{"$f":"AO42","v":false},"H（収入増）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"R",null,null,null,null,null,null,null,null,false,"S",null,false,"R（収入増）"]
[null,null,"申請事由\n\nおよび\n\n事由発生日",null,null,"■","他の社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,null,"収入の増加 ",null,null,"（",{"$f":"IF(X44=\"\",\"\",X44)","v":""},null,null,null,"円／年）",null,"【健保組合使用欄】",null,null,null,null,null,null,null,false,"H",null,false,"離婚"]
[null,null,null,null,null,null,null,"就職またはパート先等で社会保険に加入",null,null,null,null,null,null,null,null,null,null,null,"　 事由",null,"H","R",{"$f":"IF(X45=\"\",\"\",X45)","v":""},null,{"$f":"IF(Z45=\"\",\"\",Z45)","v":""},null,{"$f":"IF(AB45=\"\",\"\",AB45)","v":""},null,"資格喪失証明書発行",null,null,null,null,null,null,null,false,"R",null,false,"H（離婚）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"発生日：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"社保加入",null,false,"R（離婚）"]
[null,null,null,null,null,null,null,"他の家族の扶養家族になった",null,null,null,null,null,null,null,null,null,null,null,"離婚",null,null,null,null,null,null,null,null,null,"有　・　無",null,null,null,null,null,null,null,false,"扶養異動",null,false,"死亡"]
[null,null,null,null,null,null,"　加入日：",null,"H","R",{"$f":"IF(K48=\"\",\"\",K48)","v":""},null,{"$f":"IF(M48=\"\",\"\",M48)","v":""},null,{"$f":"IF(O48=\"\",\"\",O48)","v":""},null,null,null,null,null,"離婚日：","H","R",{"$f":"IF(X48=\"\",\"\",X48)","v":""},null,{"$f":"IF(Z48=\"\",\"\",Z48)","v":""},null,{"$f":"IF(AB48=\"\",\"\",AB48)","v":""},null,null,null,null,null,null,"登録",null,null,false,"H（社保加入）",null,false,"H（死亡）"]
[null,null,null,null,null,null,"結婚",null,null,null,null,null,null,null,null,null,null,null,null,"死亡",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"再",null,null,false,"R（社保加入）",null,false,"R（死亡）"]
[null,null,null,null,null,null,null,"　婚姻日：","H","R",{"$f":"IF(K50=\"\",\"\",K50)","v":""},null,{"$f":"IF(M50=\"\",\"\",M50)","v":""},null,{"$f":"IF(O50=\"\",\"\",O50)","v":""},null,null,null,null,null,"　死亡日：","H","R",{"$f":"IF(X50=\"\",\"\",X50)","v":""},null,{"$f":"IF(Z50=\"\",\"\",Z50)","v":""},null,{"$f":"IF(AB50=\"\",\"\",AB50)","v":""},null,null,null,null,null,null,"再",null,null,false,"結婚",null,false,"その他"]
[null,null,null,null,null,null,"被保険者と別世帯（国内）",null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,"滅失届",null,null,null,false,"H（結婚）",null,false,"H（その他）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"R（結婚）",null,false,"R（その他）"]
[null,null,null,null,null,null,"世帯を　",null,"H","R",{"$f":"IF(K53=\"\",\"\",K53)","v":""},null,{"$f":"IF(M53=\"\",\"\",M53)","v":""},null,{"$f":"IF(O53=\"\",\"\",O53)","v":""},null,null,null,null,null,{"$f":"IF(U53=\"\",\"\",U53)","v":""},null,null,null,null,null,null,null,null,"医療費精算",null,null,null,"有 ・ 無",null,null,null,false,"別世帯",null,false,"添付しました"]
[null,null,null,null,null,"分けた日：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"H（別世帯）",null,false,"添付できません"]
[null,null,null,null,null,null,"海外居住",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健診費精算",null,null,null,"有 ・ 無",null,null,null,false,"R（別世帯）",null,false,"紛失"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"海外居住",null,false,"その他（添付できません）"]
[null,null,null,null,null,null,"　 事由",null,"H","R",{"$f":"IF(K57=\"\",\"\",K57)","v":""},null,{"$f":"IF(M57=\"\",\"\",M57)","v":""},null,{"$f":"IF(O57=\"\",\"\",O57)","v":""},null,null,null,null,"　 事由",null,"H","R",{"$f":"IF(X57=\"\",\"\",X57)","v":""},null,{"$f":"IF(Z57=\"\",\"\",Z57)","v":""},null,{"$f":"IF(AB57=\"\",\"\",AB57)","v":""},null,"新証写添付",null,null,null,"有 ・ 無",null,null,null,false,"H（海外居住）"]
[null,null,null,null,null,null,"発生日：",null,null,null,null,null,null,null,null,null,null,null,null,"発生日：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"AL58","v":false},"R（海外居住"]
[null,null,"被保険者証\n回収状況\n（該当者分）",null,null,null,"添付しました",null,null,null,null,null,null,"紛失　⇒",null,"「健康保険被保険者証滅失届」を添付して下さい。",null,null,null,null,null,null,null,null,null,null,null,null,null,"削除年月日"]
[null,null,null,null,null,null,"添付できません",null,null,null,null,null,null,"その他 ⇒ 理由（",null,null,null,{"$f":"IF(R60=\"\",\"\",R60)","v":""},null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null," ※添付できない理由",null,null,null,null,null,null,null,null," 回収時期 （R",null,null,null,{"$f":"IF(T61=\"\",\"\",T61)","v":""},null,{"$f":"IF(V61=\"\",\"\",V61)","v":""},null,{"$f":"IF(X61=\"\",\"\",X61)","v":""},null,"頃）",null,null,null,null,"年",null,"月",null,"日"]
[]
[null,"最終チェック",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,"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,null,{"$f":"AL64","v":false},"被保険者作成"]
[]
[]
[null," 被保険者コメント欄 （必須項目ではありません。）",null,null,null,null,null,null,null,null,null,null," 事業所担当課コメント欄"]
[null,{"$f":"IF(B68=\"\",\"\",B68)","v":""}]
[]
[]
[]
[]
[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,"※健保組合使用欄"]
[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,"書類受理日"]

{"sheet":"注意事項","index":1,"n_rows":15,"n_cols":6,"rows_kept":15,"cut":false,"hidden":false,"merged":[[13,1,13,2],[14,1,14,2],[6,1,6,2],[9,1,9,2],[11,1,11,2],[12,1,12,2],[10,1,10,2]]}
[]
[]
[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,"の部分を、漏れなくチェック（☑）・入力して下さい。"]
[]
[]
[null,"◆",null,"１枚に２名入力できます。"]
[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。（両面印刷不可）"]
[null,null,null,"　※入力は「正」のみ"]
[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,"書類の提出先は、所属している事業所の総務人事部門となります。"]
[null,null,null,"　※健康保険組合ではありませんのでご注意下さい。"]