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["正",{"$nulls":13},"介護保険適用除外等",{"$nulls":10},"該　　当",null,null,null,"届"]
[{"$nulls":25},"非 該 当"]
[{"$nulls":35},"常務理事",{"$nulls":5},"担　当",null,null,"確　認"]
[{"$nulls":4},"①",{"$nulls":4},"②"]
[{"$nulls":5},"記   号",{"$nulls":4},"番　　号"]
[null,null,"◎※欄は記入しないでください。"]
[{"$nulls":4},"※"]
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[{"$nulls":4}," ㋖被保険者の住所　",{"$nulls":4},"〒",null,null,null,"―",{"$nulls":6},"㋗被扶養者の住所",{"$nulls":5},"〒",null,null,null,"―",{"$nulls":6},"㋘　備　　考"]
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[{"$nulls":4},"④",{"$nulls":4},"⑤",null,null,null,"⑥",{"$nulls":5}," ⑦※　\n被扶養\n者番号",null,"⑧※\n作成\n原因",null,null,null,"㋙"]
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[{"$nulls":9},"非該当",{"$nulls":4},"非該当"]
[{"$nulls":25},"㋚\n　　 入居施設の所在地\n\n\n　　 電　　話",{"$nulls":7},"〒",null,null,"―"]
[{"$nulls":4},"国外居住者   　　　       1",{"$nulls":4},"該　当　1\n非該当　2",null,null,null,"令和","年",null,"月",null,"日",{"$nulls":14},"　"]
[{"$nulls":4},"身体障害者療養施設入居者　2"]
[{"$nulls":4},"在留資格３か月以下の外国人3",{"$nulls":31},"（　",{"$nulls":4},"局）",{"$nulls":4},"番"]
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[{"$nulls":32},"令和",null,null,null,"年",null,null,"月",null,null,"日","提出"]
[{"$nulls":8},"〒",null,null,null,"―"]
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[{"$nulls":4},"事業所名称",null,null,null,"　"]
[{"$nulls":4},"事業主氏名",null,null,null,"　",{"$nulls":16},"社会保険労務士の提出代行者欄"]
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["副",{"$nulls":13},"介護保険適用除外等",{"$nulls":10},"該　　当",null,null,null,"確認通知書"]
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[{"$nulls":4},"①",{"$nulls":4},"②"]
[{"$nulls":5},"記   号",{"$nulls":4},"番　　号"]
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[{"$nulls":4},"※"]
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[{"$nulls":13},"㊞"]
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[{"$nulls":4}," ㋖被保険者の住所　",{"$nulls":4},"〒",null,null,null,"―",{"$nulls":6},"㋗被扶養者の住所",{"$nulls":5},"〒",null,null,null,"―",{"$nulls":6},"㋘　備　　考"]
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[{"$nulls":4},"④",{"$nulls":4},"⑤",null,null,null,"⑥",{"$nulls":5}," ⑦※　\n被扶養\n者番号",null,"⑧※\n作成\n原因",null,null,null,"㋙"]
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[{"$nulls":9},"非該当",{"$nulls":4},"非該当"]
[{"$nulls":25},"㋚\n　　 入居施設の所在地\n\n\n　　 電　　話",{"$nulls":7},"〒",null,null,"―"]
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[{"$nulls":4},"身体障害者療養施設入居者　2"]
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[{"$nulls":33},"上記のとおり介護保険適用除外等該当届又は\n非該当届の確認をしましたので通知します。"]
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[{"$nulls":4},"事業主氏名",null,null,null,"　",{"$nulls":24},"中部アイティ産業健康保険組合理事長"]
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[]
[null,"　　【記入の方法】"]
[null,null,"1.","㋑及び㋓の性別は、該当する数字を○で囲んでください。"]
[null,null,"2.","③及び㋕の生年月日は、たとえば、昭和52年2月7日生まれの場合　　　　"]
[]
[{"$nulls":5},"昭5",null,null,"年",null,"月",null,"日"]
[{"$nulls":14},"のように記入してください。"]
[{"$nulls":5},"平7",null,5,2,0,2,0,7]
[]
[]
[null,null,"3.","㋔は、被保険者との続柄を、「夫」､「妻」、「父」、「母」、「子」、「祖父」、「祖母」、など詳しく記入してください。"]
[null,null,"4.","④の適用除外等の事由は、該当する数字を○で囲んでください。"]
[null,null,"5.","⑤の該当・非該当の別は、該当する数字を○で囲んでください。"]
[null,null,"6.","⑥の該当・非該当の年月日は、たとえば、令和1年5月16日の場合は"]
[]
[{"$nulls":7},"令和","年",null,"月",null,"日"]
[{"$nulls":14},"のように記入してください。"]
[{"$nulls":7},0,1,0,5,1,6]
[]
[]
[null,null,"7.","転勤により国内から国外へ又は外国から国内へ転居した場合には、㋘にその旨を明記してください。"]
[null,null,"8.","㋙及び㋚は、④で2に○をされた方のみ記入してください。"]
[]
["　"]
[null,"　　【この届に添付して提出するもの】"]
[null,null,"1.","④の適用除外等の事由で、1に○をされた方は、「住民票の除票」。"]
[null,null,"2.","④の適用除外等の事由で、2に○をされた方は、「入所・入院の証明書」。"]
[null,null,"3.","④の適用除外等の事由で、3に○をされた方は、在留期間を証明する書類（旅券（パスポート）の裏面に押される「上陸許可認印（写）」、"]
[null,null,null,"「資格外活動許可書（写）」など）及び雇用契約期間を証明できる「雇用契約書」など。"]
[null,null,null,"　"]