{"text_format":"2","workbook":"xls","n_sheets":1,"sheets":["出産育児一時金支給申請書 (全額請求)"],"not_rendered":{"charts":0,"images":0,"macros":0,"external_links":1,"defined_names":1,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"run_cost":"one","rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900","formulas":"cached_only"}

{"sheet":"出産育児一時金支給申請書 (全額請求)","index":0,"n_rows":67,"n_cols":26,"rows_kept":67,"cut":false,"hidden":false,"merged":[[62,6,62,13],[59,3,59,13],[59,14,59,16],[59,17,59,19],[59,20,59,22],[59,23,59,25],[60,20,62,22],[57,14,57,19],[57,20,57,25],[58,4,58,5],[58,6,58,13],[58,14,58,19],[60,23,62,25],[61,2,61,5],[61,6,61,13],[62,2,62,5],[58,20,58,25],[55,1,55,25],[57,0,62,1],[57,2,59,2],[57,3,58,3],[57,4,57,5],[60,2,60,5],[60,6,60,13],[60,14,62,16],[60,17,62,19],[57,6,57,13],[48,1,48,4],[48,5,48,17],[48,18,48,21],[48,22,48,25],[49,1,49,4],[49,5,49,10],[49,11,49,13],[49,14,49,17],[49,18,49,21],[49,22,49,25],[38,20,38,21],[38,23,38,24],[39,1,39,5],[39,6,39,12],[39,13,39,16],[39,17,39,18],[39,20,39,21],[39,22,39,23],[39,24,39,25],[35,26,35,29],[36,1,36,12],[36,13,36,16],[36,18,36,20],[36,22,36,24],[38,0,55,0],[38,1,38,5],[38,6,38,12],[38,13,38,16],[38,17,38,18],[32,1,32,12],[32,20,32,24],[34,13,35,16],[34,17,35,17],[34,18,35,24],[34,25,35,25],[35,1,35,12],[27,20,28,20],[27,21,28,22],[27,23,28,23],[27,24,28,25],[30,13,33,13],[30,18,30,21],[30,23,30,25],[31,18,31,21],[31,23,31,25],[24,6,26,7],[27,3,28,5],[27,6,28,12],[27,13,28,16],[27,17,28,17],[27,18,28,19],[17,24,17,25],[18,15,19,16],[18,17,19,19],[18,20,19,25],[21,3,23,5],[21,6,23,12],[21,15,22,19],[21,20,22,25],[23,13,26,16],[24,3,26,5],[15,18,15,19],[15,20,17,23],[20,15,20,19],[20,20,20,25],[21,1,28,2],[15,24,15,25],[16,18,16,19],[16,24,16,25],[17,1,20,4],[17,18,17,19],[1,4,1,6],[1,7,2,17],[1,20,4,25],[2,4,2,6],[6,1,6,4],[6,5,7,7],[6,8,7,9],[6,10,7,12],[7,1,7,4],[6,23,7,24],[6,17,7,18],[6,19,7,19],[6,22,7,22],[6,25,7,25],[6,20,7,21],[0,20,0,25],[10,1,10,7],[6,0,36,0],[12,1,14,4],[12,5,14,12],[17,12,18,12],[6,13,7,16],[15,1,16,4],[15,5,16,12],[15,13,22,14],[15,15,17,17],[17,10,18,10],[17,8,18,8],[17,5,18,7],[17,9,18,9],[17,11,18,11],[19,11,20,12],[19,5,20,8],[19,9,20,10],[23,21,23,25],[24,8,26,8],[24,9,26,9],[24,10,26,10],[24,11,26,11],[24,12,26,12],[23,18,23,19],[24,17,26,25]],"flags":["formulas_cached_only"]}
[{"$nulls":20},"健保組合受付印"]
[{"$nulls":4},"被保険者",null,null,"出産育児一時金支給申請書"]
[{"$nulls":4},"家　　　族"]
["中部アイティ産業健康保険組合　　　御中"]
[]
[]
["請 求 者 の 記 入 欄","被保険者等",{"$nulls":6},"－",{"$nulls":4},"請求年月日",{"$nulls":5},"年",null,null,"月",null,null,"日"]
[null,"記号・番号"]
[]
[null,"記号番号が分からない場合はマイナンバーを記入してください。"]
[null,"被保険者のマイナンバー記入欄"]
[]
[null,"被保険者名",{"$nulls":11},"□","マイナポータル等で事前登録した公金口座を利用します。"]
[{"$nulls":14},"（利用する場合は□にチェック、利用しない場合は下記の欄を記入。）"]
[{"$nulls":14},"注）口座情報の反映には登録から数日を要します。"]
[null,"事業所名",{"$nulls":11},"被保険者\n銀行口座",{"$nulls":4},"銀行",{"$nulls":5},"本店"]
[{"$nulls":18},"金庫",{"$nulls":5},"支店"]
[null,"分 娩 年 月 日",{"$nulls":6},"年",null,"月",null,"日",{"$nulls":5},"農協",{"$nulls":5},"出張所"]
[{"$nulls":15},"普通",null,"口座番号"]
[{"$nulls":5},"生産　・ 　死産　(",{"$nulls":5},"ヵ月 ）"]
[{"$nulls":15},"ﾌﾘｶﾞﾅ"]
[null,"分 娩 者",null,"氏　　名",{"$nulls":11},"口座名義"]
[]
[{"$nulls":13},"住　　　所",null,null,null,"〒",null,null,"-"]
[null,null,null,"生年月日",{"$nulls":4},"年",null,"月",null,"日"]
[]
[]
[null,null,null,"続　　柄",{"$nulls":9},"連 絡 先",null,null,null,"(",null,null,")",null,null,"-"]
[]
[null,"（被保険者が出産したとき）"]
[null,"資格喪失後の請求ですか？",{"$nulls":11},"いずれか","・協会けんぽ",null,null,"（",{"$nulls":4},"）","支部"]
[null,"　はい　　・　　いいえ　　→「はい」のときは右の欄に資格喪失後に加入",{"$nulls":12},"・健康保険組合　",null,null,"（",{"$nulls":4},"）","健康保険組合"]
[null,"　　　　　　　　　　　　　　　　している健康保険組合についてご記入下さい。",{"$nulls":12},"・国民健康保険　",null,null,"市町村名",null,"（",{"$nulls":5},"）"]
[null,"（家族が出産したとき）"]
[null,"家族が退職後6カ月以内の請求ですか？　",{"$nulls":11},"被保険者の氏名",null,null,null,"(",{"$nulls":7},"）"]
[null,"   はい　　・　　いいえ　 →「はい」のときは右の欄に退職前に加入して"]
[null,"　　　　　 　　　　　　いた健康保険組合についてご記入下さい。",{"$nulls":11},"記号・番号",null,null,null,"(",null,null,null,"-",null,null,null,"）"]
[]
["医師・助産師又は市区町村長の証明","分 娩 者 氏 名",{"$nulls":11},"分娩年月日",{"$nulls":5},"年",null,null,"月",null,null,"日"]
[null,"生産又は死産の別",{"$nulls":4},"生産 ・ 死産(　　　ヵ月)　 男 ・女",{"$nulls":6},"出世児の数",null,null,null,"単胎",null,"・","多胎（",null,null,null,"児）"]
[null,null,"上記のとおり相違ないことを証明する。",{"$nulls":9},"　　　　　　　年　　　　　月　　　　　日"]
[]
[null,null,"医療施設の名称・所在地"]
[]
[null,null,"            医師・助産師名"]
[]
[null,null,"            電　　　　　　　話"]
[]
[null,"本　　　　籍",{"$nulls":16},"筆頭者氏名"]
[null,"出生届出日",{"$nulls":9},"出生児氏名",{"$nulls":6},"出生年月日"]
[null,null,"上記のとおり相違ないことを証明する。"]
[null,null,null,"　　　　　　　年　　　　　月　　　　　日"]
[]
[{"$nulls":7},"市 区 町 村 長 名",{"$nulls":15},"印"]
[]
[null,"※ご記入いただいた内容を訂正する場合は、訂正箇所を二重線で抹消し、正しい内容と証明者の氏名（サイン）をご記入ください。"]
[]
["健保組合処理欄",null,"本　人","資格","取　得",null,"　　　　年　　　　　月　　　　　日",{"$nulls":7},"産科医療補償制度",{"$nulls":5},"有 　・　 無"]
[{"$nulls":4},"喪　失",null,"　　　　年　　　　　月　　　　　日",{"$nulls":7},"支給金額"]
[null,null,null,"被保険者期間　1年以上　　　有　　・　無",{"$nulls":10},"常務理事",null,null,"事務長",null,null,"担　当",null,null,"確　認"]
[null,null,"被扶養者認定日",null,null,null,"　　　　年　　　　　月　　　　　日"]
[null,null,"支給決定日",null,null,null,"　　　　年　　　　　月　　　　　日"]
[null,null,"支　給　日",null,null,null,"　　　　年　　　　　月　　　　　日"]
["（注）","1.","この出産育児一時金の請求は妊娠４ｶ月以上の胎児を分娩した場合に請求してください。"]
[null,"2.","希望振込銀行は被保険者名義の口座をご記入下さい。"]
[null,"3.","医療機関等から交付される出産費用の領収・明細書の写しと合意文書の写しを添付してください。"]
[{"$nulls":25},"2024年12月更新"]