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["　　　　　　　　　　被　　扶　　養　　者　　届　　入　　力　　画　　面"]
["事業所の所在地",null,null,null,"※事業主確認で本人の押印・署名を省略した場合は、下記にチェックしてください。"]
["名称",null,null,null,null,"扶養認定を受ける方の続柄については、届書の記載と相違ないことを確認しました。",null,null,null,null,true]
["事業主名",null,null,null,null,"本人押印・署名の省略にあたり被保険者に届出意思を確認しました。",null,null,null,null,true]
["事業所郵便番号",null,null,null,null,"本人押印・署名の省略にあたり記載内容について誤りがないか被保険者本人が確認しています。",null,null,null,null,true]
["事業所電話番号"]
["被保険者","例",null,"被保険者入力欄"]
["提出日","自動入力　　→",null,{"$f":"TODAY()","v":"2024-05-24"}]
["記号",99]
["番号",999]
["被保険者氏名","健保","太郎"]
["生年月日","1970-04-01"]
["〒","930","0992"]
["住所","富山市新庄町（9文字まで）"]
["〃","字馬場１８－８（9文字まで）"]
["電話番号","４２４－３３２２"]
["資格取得日","2001-04-01"]
["標準報酬月額（千円）",98]
[null,null,null,null,null,"被保険者","被扶養者"]
[]
[]
[]
["被扶養者","例",null,"被扶養者入力欄－①",null,"被扶養者入力欄－②",null,"被扶養者入力欄－③"]
["扶養者の増・減","増"]
["フリガナ",{"$f":"ASC(PHONETIC(B26))","v":"ｹﾝﾎﾟ"},"ﾊﾅｺ","","","","","",""]
["被扶養者名","健保","花子"]
["性　別","女"]
["生年月日","1971-04-20"]
["被保険者との続柄","妻"]
["扶養し始めた又は","2018-10-01"]
["扶養しなくなった日"]
["理　由","結　婚"]
["〃"]
["同居・別居の別","同　居"]
["被扶養者の職業","アルバイト"]
["被扶養者の月平均の収入額",80000]
["被扶養者の収入の種別","時給"]
["扶養し始めた時（直前）に被扶養者が加入していた健康保険の種別","②国民健康保険"]
["①健康保険　　　　　　　②国民健康保険　　　　③その他の保険　　　　④加入していない"]
["保険の記号番号","111-1234"]
["失業保険の受給","無"]
["個人番号（12桁）","123456789000"]
[]
[]
["　　　　　　　　　　　　　被　　扶　　養　　者　　届　　印　　刷　　画　　面"]
[]
["扶養届の印刷"]

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[null,"※事業主の確認により本人の押印・署名を省略した場合には、右記の該当するものにチェックしてください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本人押印・署名の省略にあたり被保険者に届出意思を確認しました。"]
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[]
["備　考"]

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[]
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["番号",{"$f":"入力画面!D10","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,"印",null,null,null,null,null,null,null,null,null,{"$f":"入力画面!D15","v":0}]
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[]
["増減の別",null,"フ　リ　ガ　ナ",null,null,null,null,null,null,null,null,"被保険者","との続柄","扶養し始めた",null,null,null,null,null,null,null,null,"同居別居","の",null,null,null,"被扶養者の収入",null,null,null,null,"扶養し始めた時（直前）に",null,null,null,null,null,null,null,null,null,"失業保険","受給","個人番号記載欄（１２桁） 　　　　　　  ※扶養削除の場合は記載不要です"]
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[]
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[]
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[]
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[]
[{"$f":"入力画面!H24","v":0},{"$f":"入力画面!H25","v":""},null,null,null,null,{"$f":"入力画面!I25","v":""},null,null,null,{"$f":"入力画面!H27","v":0}]
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[]
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[]
["備　考"]
[]
[]
[]
[]
[]
[]
["　この処分に不服があるときは、処分があったことを知った日の翌日から起算して３か月以内に文書又は口頭で社会保険審査官（地方厚生（支）局内）に対して審査請求をすることができます。また、審査請求の決定に不服があるときは、再審査請求又は処分の取消しの訴えを提起することができます。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和　　　　年　　　　月　　　　日"]
[]
["　再審査請求は、審査官の決定書の謄本が送付された日の翌日から起算して２か月以内に文書又は口頭で社会保険審査会（厚生労働省内）に対して行うことができ、処分の取消しの訴えは、審査請求の決定があったことを知った日から６か月以内（再審査請求があったときは、その裁決があったことを知った日から６か月以内）に、健康保険組合を被告として提起することができます。（ただし、原則として、決定又は裁決の日から１年を経過したときは、提起することができなくなります。）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"富山県自動車販売店健康保険組合"]
["　なお、審査請求があった日から２か月を経過しても決定がないときや、処分の執行等による著しい損害を避けるため緊急の必要があるとき、その他正当な理由があるときは、審査請求の決定を経なくても再審査請求又は処分の取消しの訴えを提起することができます。"]