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[null,"①　氏名",null,"氏のみ\n漢字"]
[null,null,null,"名のみ\n漢字"]
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[null,null,null,"名のみ\nﾌﾘｶﾞﾅ(半角)"]
[null,"②　生年月日",null,"元号"]
[null,null,null,"年"]
[null,null,null,"月"]
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[null,null,"都道府県",null,null,null,null,null,null,"注）都・道・府・県まで入力してください。"]
[null,null,"都道府県以外住所"]
[null,null,"ﾌﾘｶﾞﾅ(半角)"]
[]
[null,"B．第3号被保険者欄＝扶養される配偶者（妻）"]
[null,"①　氏名","届出年月日","年",null,null,null,null,null,"(入力不要)"]
[null,null,null,"月"]
[null,null,null,"日"]
[null,null,"氏名","氏名\n漢字"]
[null,null,null,"氏名\nﾌﾘｶﾞﾅ(半角)"]
[null,null,"委任","1.する",null,null,null,"(入力不要)"]
[null,"②　生年月日",null,"元号"]
[null,null,null,"年"]
[null,null,null,"月"]
[null,null,null,"日"]
[null,"③　性別（続柄）"]
[null,"④　個人番号\n　　[基礎年金番号]",null,null,null,null,null,null,null,null,null,null,null,null,null,"（個人番号入力必須）"]
[null,"⑦　住所","同居・別居"]
[null,null,"〒",null,null,"-"]
[null,null,"住所"]
[null,"⑧　電話番号"]
[null,null,null,null,null,null,"（",null,null,null,"）"]
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[null,"該当","⑨　第3号被保険者\n　　になった日","元号"]
[null,null,null,"年"]
[null,null,null,"月"]
[null,null,null,"日"]
[null,null,"⑩　理由",null,null,null,null,"その他理由"]
[null,null,"⑪\n配偶者の加入制度","31.厚生年金保険・健康保険"]
[null,"非該当","⑫　第3号被保険者\n　　でなくなった日","元号"]
[null,null,null,"年"]
[null,null,null,"月"]
[null,null,null,"日"]
[null,null,"⑬　理由",null,null,null,null,"その他理由"]
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[null,null,null,"月"]
[null,null,null,"日"]

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[]
[null,"様式コード",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"国民年金",null,null,null,null,null,null,null,null,null,"第３号被保険者関係届"]
[null,4,null,3,null,0,null,null,0]
[]
[null,"令和　　　　　　　年　　　　　　　月　　　　　　　日提出"]
[]
[null,"提出者情報",null,null,null,null,null,null,null,null,null,null,"届出記入の個人番号（基礎年金番号）に誤りがないことを確認しました。",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,null,null,null,null,null,null,null,null,null,null,null,null,"日本年金機構"]
[]
[null,null,null,null,null,null,null,"事業所\n所在地",null,null,null,null,"〒",721,null,null,"－",8555]
[null,null,null,null,null,null,null,null,null,null,null,null,"福山市東深津町四丁目２０番１号"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,"事業所\n名 　称",null,null,null,null,"福山通運株式会社"]
[]
[]
[]
[null,null,null,null,null,null,null,"事業主\n氏　 名",null,null,null,null,"代表取締役　小丸　成洋"]
[]
[]
[null,null,null,null,null,null,null,"電話番号",null,null,null,null,"（　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,null,"事業主等\n受付年月日",null,null,null,null,null,null,null,null,"令和　　　　　　年　　　　　　月　　　　　　日"]
[]
[]
[]
[null,null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,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"," 生年月日",null,null,null,null,null,"5. 昭和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"③",null,"1.男性　2.女性"]
[null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"７. 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,"④"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号\n[基礎年金番号]"]
[]
[]
[null,null,null,null,null,null,null,"⑤",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　（フリガナ）"]
[null,null,null,null,null,null,null,"住所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,"－"]
[]
[]
[]
[null,"　　届出内容に応じて、該当・非該当（変更）のいずれかを○で囲み、記入してください。"]
[]
[]
[null,null,null,null,null,null,null,"①",null,null,null,null,"この届書記載のとおり届出します。",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,"②",null,null,null,null,null,null,"5. 昭和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"③",null,"1.夫　3.夫（未届）\n2.妻　4.妻（未届）"]
[null,null,null,null,null,null,null,"氏名\n",null,null,null,null,"令和　　　　年　　　　月　　　　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,"生年月日\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別\n（続柄）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"７. 平成"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"日本年金機構理事長あて",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（ﾌﾘｶﾞﾅ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号\n[基礎年金番号]"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（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,null,null,"⑤",null,null,null,null,null,null,null,null,null,null,null,"⑥",null,null,null,"（ﾌﾘｶﾞﾅ）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"※届書の提出は配偶者（第２号被保険者）に委任します□",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,"外国籍",null,null,null,null,null,null,null,null,null,null,null,"外国人\n通称名"]
[]
[null,null,null,null,null,null,null,"⑦",null,null,null,null,"同居\n・\n別居",null,null,null,null,"〒",null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,"1.自宅 　2.携帯　 3.勤務先 　4.その他"]
[null,null,null,null,null,null,null,"住所\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話\n番号\n"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（　　　　　　）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※同居の場合も住民票の住所を記入してください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"7. 平成\n9. 令和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"⑩",null,null,null,"　1. 配偶者の就職　　4. 収入減少\n　2. 婚姻　　　　　　　　5. その他\n　3. 離職　　　　　　　　 （                       ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑭"]
[null,null,null,null,null,null,null,null,null,null,null,null,"第3号被保険者\nになった日\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由\n"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"⑪",null,null,null,null,"　31.厚生年金保険・健康保険   36.地方公務員等共済組合　　　　     30.厚生年金保険・船員保険\n　32.国家公務員共済組合     　 37.日本私立学校振興・共済事業団",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備　考"]
[null,null,null,null,null,null,null,null,null,null,null,null,"配偶者の\n加入制度"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"⑫",null,null,null,null,"7. 平成\n9. 令和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"⑬",null,null,null,"　1. 死亡 （　　　　　　年　　　　月　　　　日）\n　2. 離婚  3. 収入増加　6. その他（　　　　　 ）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"第3号被保険者でなくなった日\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由\n"]
[]
[]
[null,"　健康保険証の発行元に確認を受けてください。　※届書記載の配偶者が協会けんぽ加入者の場合は、確認不要です。"]
[]
[]
[null,"医療保険者記入欄",null,null,null,null,null,"組合（保険者）番号",null,null,null,null,null,null,null,null,null,"06340400"]
[]
[null,null,null,null,null,null,null,"上記のとおり第３号被保険者関係届の届出がありましたので提出します。"]
[]
[null,null,null,null,null,null,null,"届出記載の第３号被保険者は、健康保険組合又は共済組合に加入している者の被扶養者であることを確認する。"]
[null,null,null,null,null,null,null,"認定年月日",null,null,null,null,null,"令和",null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日",null,null,null,null,"（「⑨第３号被保険者になった日」と同じ場合は、記載の必要はありません）"]
[]
[null,null,null,null,null,null,null,"所在地",null,null,null,null,null,"〒","720",null,null,"-","0061"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"福山市丸之内二丁目８－２０－３０２"]
[]
[]
[null,null,null,null,null,null,null,"名　 称",null,null,null,null,null,"福山通運健康保険組合"]
[]
[]
[null,null,null,null,null,null,null,"代表者\n等氏名",null,null,null,null,null,"理事長　小丸　成洋"]
[]
[]
[]
[null,null,null,null,null,null,null,"電　話",null,null,null,null,null,"084（　　　 　924　　 　　）2012"]

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[]
[null,"様式コード",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"国民年金",null,null,null,null,null,null,null,null,null,"第３号被保険者関係届"]
[null,4,null,3,null,0,null,null,0]
[]
[null,"令和　　　　　　　年　　　　　　　月　　　　　　　日提出"]
[]
[null,"提出者情報",null,null,null,null,null,null,null,null,null,null,"届出記入の個人番号（基礎年金番号）に誤りがないことを確認しました。",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,null,null,null,null,null,null,null,null,null,null,null,null,"日本年金機構"]
[]
[null,null,null,null,null,null,null,"事業所\n所在地",null,null,null,null,"〒",721,null,null,"－",8555]
[null,null,null,null,null,null,null,null,null,null,null,null,"福山市東深津町四丁目２０番１号"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,"事業所\n名 　称",null,null,null,null,"福山通運株式会社"]
[]
[]
[]
[null,null,null,null,null,null,null,"事業主\n氏　 名",null,null,null,null,"代表取締役　小丸　成洋"]
[]
[]
[null,null,null,null,null,null,null,"電話番号",null,null,null,null,"（　　　　　　　　　　）"]
[]
[null,null,null,null,null,null,null,"事業主等\n受付年月日",null,null,null,null,null,null,null,null,"令和　　　　　　年　　　　　　月　　　　　　日"]
[]
[]
[]
[null,null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,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"," 生年月日",null,null,null,null,null,"5. 昭和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"③",null,"1.男性　2.女性"]
[null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"７. 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,"④"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号\n[基礎年金番号]"]
[]
[]
[null,null,null,null,null,null,null,"⑤",null,null,null,null,"個人番号を記入した場合は、住所記載は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　（フリガナ）"]
[null,null,null,null,null,null,null,"住所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,"－"]
[]
[]
[]
[null,"　　届出内容に応じて、該当・非該当（変更）のいずれかを○で囲み、記入してください。"]
[]
[]
[null,null,null,null,null,null,null,"①",null,null,null,null,"この届書記載のとおり届出します。",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,"②",null,null,null,null,null,null,"5. 昭和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"③",null,"1.夫　3.夫（未届）\n2.妻　4.妻（未届）"]
[null,null,null,null,null,null,null,"氏名\n",null,null,null,null,"令和　　　　年　　　　月　　　　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,"生年月日\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別\n（続柄）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"７. 平成"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"日本年金機構理事長あて",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"④"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（ﾌﾘｶﾞﾅ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号\n[基礎年金番号]"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（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,null,null,"⑤",null,null,null,null,null,null,null,null,null,null,null,"⑥",null,null,null,"（ﾌﾘｶﾞﾅ）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"※届書の提出は配偶者（第２号被保険者）に委任します□",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,"外国籍",null,null,null,null,null,null,null,null,null,null,null,"外国人\n通称名"]
[]
[null,null,null,null,null,null,null,"⑦",null,null,null,null,"同居\n・\n別居",null,null,null,null,"〒",null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑧",null,null,null,"1.自宅 　2.携帯　 3.勤務先 　4.その他"]
[null,null,null,null,null,null,null,"住所\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話\n番号\n"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（　　　　　　）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※同居の場合も住民票の住所を記入してください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,"⑨",null,null,null,null,"7. 平成\n9. 令和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"⑩",null,null,null,"　1. 配偶者の就職　　4. 収入減少\n　2. 婚姻　　　　　　　　5. その他\n　3. 離職　　　　　　　　 （                       ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑭"]
[null,null,null,null,null,null,null,null,null,null,null,null,"第3号被保険者\nになった日\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由\n"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"⑪",null,null,null,null,"　31.厚生年金保険・健康保険   36.地方公務員等共済組合　　　　     30.厚生年金保険・船員保険\n　32.国家公務員共済組合     　 37.日本私立学校振興・共済事業団",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備　考"]
[null,null,null,null,null,null,null,null,null,null,null,null,"配偶者の\n加入制度"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"⑫",null,null,null,null,"7. 平成\n9. 令和",null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"⑬",null,null,null,"　1. 死亡 （　　　　　　年　　　　月　　　　日）\n　2. 離婚  3. 収入増加　6. その他（　　　　　 ）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"第3号被保険者でなくなった日\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"理由\n"]
[]
[]
[null,"　健康保険証の発行元に確認を受けてください。　※届書記載の配偶者が協会けんぽ加入者の場合は、確認不要です。"]
[]
[]
[null,"医療保険者記入欄",null,null,null,null,null,"組合（保険者）番号",null,null,null,null,null,null,null,null,null,"06340400"]
[]
[null,null,null,null,null,null,null,"上記のとおり第３号被保険者関係届の届出がありましたので提出します。"]
[]
[null,null,null,null,null,null,null,"届出記載の第３号被保険者は、健康保険組合又は共済組合に加入している者の被扶養者であることを確認する。"]
[null,null,null,null,null,null,null,"認定年月日",null,null,null,null,null,"令和",null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日",null,null,null,null,"（「⑨第３号被保険者になった日」と同じ場合は、記載の必要はありません）"]
[]
[null,null,null,null,null,null,null,"所在地",null,null,null,null,null,"〒",721,null,null,"-","0974"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"福山市丸之内二丁目８－２０－３０２"]
[]
[]
[null,null,null,null,null,null,null,"名　 称",null,null,null,null,null,"福山通運健康保険組合"]
[]
[]
[null,null,null,null,null,null,null,"代表者\n等氏名",null,null,null,null,null,"理事長　小丸　成洋"]
[]
[]
[]
[null,null,null,null,null,null,null,"電　話",null,null,null,null,null,"084（　　　 　924　　 　　）2012"]

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