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["正",null,null,null,null,"健康保険　被保険者資格取得届",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,"事務局長",null,null,"部長",null,null,"課長",null,null,"課長補佐",null,null,"担当者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・黄色部分に入力、チェックして印刷してください。入力、チェックされた箇所は、",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"副","に反映されます。"]
[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,null,null,null,null,null,"・印刷する際は、「A４　両面（長辺綴じ）」で印刷してください。白黒でもカラーでも結構です。"]
["令和",null,null,null,"年",null,"月",null,"日","提出",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・セルを結合したり、列や行を追加・削除しないでください。リセットボタンが正常に動作しなくなります。"]
["提出者記入欄",null,null,null,"　届書記入の個人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,"・ご使用のプリンターにより、A４用紙に納まらない場合は列や行を追加・削除するのではなく、"]
[null,"事業所\n所在地",null,null,null,"〒　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健康保険の記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　以下の方法で対応してください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　1）余白を調整する。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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）印刷を拡大・縮小する。"]
[null,"事業所\n名　称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　3）空欄の「行」の高さを調整する"]
[]
[null,"事業主\n氏　名",null,null,"　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　\n　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険労務士記載欄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"前回入力した情報を保存している場合は、別人の情報が残るのを避けるため"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　","　　氏　　名　　等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下のリセットボタンを押して、全て消去してから入力してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"→"]
[null,"電話番号"]
[]
[]
["被保険者１","①",null,null,null,null,null,null,null,null,"②",null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,null,null,null,null,null,"④"]
[null,"被保険者\n等番号",null,null,null,null,null,null,null,null,"(ﾌﾘｶﾞﾅ)",null,"（氏）",null,null,null,null,null,"（名）",null,null,null,null,null,"生 年\n月 日",null,null,null,null,null,null,null,null,null,null,null,null,"性別\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,null,null,null,null,null,null,"氏名"]
[null,"⑤",null,null,"　1. 健保・厚年",null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,null,null,null,null,null,"⑧"]
[null,"取 得\n区 分",null,null,"　3. 共済出向",null,null,null,null,null,"個 人\n番 号",null,null,null,null,null,null,null,null,null,null,null,null,null,"取得(該当)\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,"　4 .船保任継",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"ChkD!F2","v":""}]
[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,null,null,null,null,null,null,"円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
[null,"報 酬\n月 額",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(G22=(\"\"),(\"\"),G22+G24)","v":""},null,null,null,null,null,null,{"$f":"IF(N23=(\"\"),(\"\"),VLOOKUP(N23,等級表!A:C,3,1))","v":""},null,null,null,"備 考"]
[null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,"二以上事業所勤務者の取得",null,null,null,null,null,null,null,"退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円",null,null,null,false,"短時間労働者の取得(特定適用事業所等)",null,null,null,null,null,null,null,"その他","（　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,"）"]
[null,"⑫",null,null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所が空欄の場合は該当する項目にチェックを入れてください。",null,null,null,null,null,null,null,null,null,"⑬",null,null,"発行が必要の場合はチェックを"]
[null,"住民票\n住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,null,"海外在住",null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,"入れてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,null,"短期在留",null,null,null,null,null,null,null,null,null,null,false,null,null,"発行が必要"]
[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,null,"その他（",null,null,null,null,null,null,"）"]
[]
["被保険者２","①",null,null,null,null,null,null,null,null,"②",null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,null,null,null,null,null,"④"]
[null,"被保険者\n等番号",null,null,null,null,null,null,null,null,"(ﾌﾘｶﾞﾅ)",null,"（氏）",null,null,null,null,null,"（名）",null,null,null,null,null,"生 年\n月 日",null,null,null,null,null,null,null,null,null,null,null,null,"性別\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,null,null,null,null,null,null,"氏名"]
[null,"⑤",null,null,"　1. 健保・厚年",null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,null,null,null,null,null,"⑧"]
[null,"取 得\n区 分",null,null,"　3. 共済出向",null,null,null,null,null,"個 人\n番 号",null,null,null,null,null,null,null,null,null,null,null,null,null,"取得(該当)\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,"　4 .船保任継",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":"ChkD!F3","v":""}]
[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,null,null,null,null,null,null,"円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
[null,"報 酬\n月 額",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(G37=(\"\"),(\"\"),G37+G39)","v":""},null,null,null,null,null,null,{"$f":"IF(N38=(\"\"),(\"\"),VLOOKUP(N38,等級表!A:C,3,1))","v":""},null,null,null,"備 考"]
[null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"二以上事業所勤務者の取得",null,null,null,null,null,null,null,"退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円",null,null,null,null,"短時間労働者の取得(特定適用事業所等)",null,null,null,null,null,null,null,"その他","（　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,"）"]
[null,"⑫",null,null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所が空欄の場合は該当する項目にチェックを入れてください。",null,null,null,null,null,null,null,null,null,"⑬",null,null,"発行が必要の場合はチェックを"]
[null,"住民票\n住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"海外在住",null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,"入れてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"短期在留",null,null,null,null,null,null,null,null,null,null,null,null,null,"発行が必要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他（",null,null,null,null,null,null,"）"]
[]
["被保険者３","①",null,null,null,null,null,null,null,null,"②",null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,null,null,null,null,null,"④"]
[null,"被保険者\n等番号",null,null,null,null,null,null,null,null,"(ﾌﾘｶﾞﾅ)",null,"（氏）",null,null,null,null,null,"（名）",null,null,null,null,null,"生 年\n月 日",null,null,null,null,null,null,null,null,null,null,null,null,"性別\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,null,null,null,null,null,null,"氏名"]
[null,"⑤",null,null,"　1. 健保・厚年",null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,null,null,null,null,null,"⑧"]
[null,"取 得\n区 分",null,null,"　3. 共済出向",null,null,null,null,null,"個 人\n番 号",null,null,null,null,null,null,null,null,null,null,null,null,null,"取得(該当)\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,"　4 .船保任継",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"ChkD!F4","v":""}]
[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,null,null,null,null,null,null,"円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
[null,"報 酬\n月 額",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(G52=(\"\"),(\"\"),G52+G54)","v":""},null,null,null,null,null,null,{"$f":"IF(N53=(\"\"),(\"\"),VLOOKUP(N53,等級表!A:C,3,1))","v":""},null,null,null,"備 考"]
[null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"二以上事業所勤務者の取得",null,null,null,null,null,null,null,"退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円",null,null,null,null,"短時間労働者の取得(特定適用事業所等)",null,null,null,null,null,null,null,"その他","（　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,"）"]
[null,"⑫",null,null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所が空欄の場合は該当する項目にチェックを入れてください。",null,null,null,null,null,null,null,null,null,"⑬",null,null,"発行が必要の場合はチェックを"]
[null,"住民票\n住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"海外在住",null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,"入れてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"短期在留",null,null,null,null,null,null,null,null,null,null,null,null,null,"発行が必要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他（",null,null,null,null,null,null,"）"]
[]
["被保険者４","①",null,null,null,null,null,null,null,null,"②",null,null,null,null,null,null,null,null,null,null,null,null,null,"③",null,null,null,null,null,null,null,null,null,null,null,null,"④"]
[null,"被保険者\n等番号",null,null,null,null,null,null,null,null,"(ﾌﾘｶﾞﾅ)",null,"（氏）",null,null,null,null,null,"（名）",null,null,null,null,null,"生 年\n月 日",null,null,null,null,null,null,null,null,null,null,null,null,"性別\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,null,null,null,null,null,null,"氏名"]
[null,"⑤",null,null,"　1. 健保・厚年",null,null,null,null,null,"⑥",null,null,null,null,null,null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,null,null,null,null,null,"⑧"]
[null,"取 得\n区 分",null,null,"　3. 共済出向",null,null,null,null,null,"個 人\n番 号",null,null,null,null,null,null,null,null,null,null,null,null,null,"取得(該当)\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,"被扶養者\n(ﾌﾟﾙﾀﾞｳﾝ)"]
[null,null,null,null,"　4 .船保任継",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":"ChkD!F5","v":""}]
[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,null,null,null,null,null,null,"円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
[null,"報 酬\n月 額",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(G67=(\"\"),(\"\"),G67+G69)","v":""},null,null,null,null,null,null,{"$f":"IF(N68=(\"\"),(\"\"),VLOOKUP(N68,等級表!A:C,3,1))","v":""},null,null,null,"備 考"]
[null,null,null,null,"㋑（現物）",null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"二以上事業所勤務者の取得",null,null,null,null,null,null,null,"退職後の継続再雇用者の取得"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円",null,null,null,null,"短時間労働者の取得(特定適用事業所等)",null,null,null,null,null,null,null,"その他","（　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,"）"]
[null,"⑫",null,null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所が空欄の場合は該当する項目にチェックを入れてください。",null,null,null,null,null,null,null,null,null,"⑬",null,null,"発行が必要の場合はチェックを"]
[null,"住民票\n住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"海外在住",null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,"入れてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"短期在留",null,null,null,null,null,null,null,null,null,null,null,null,null,"発行が必要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"東京金属事業健康保険組合"]
[null,null,null,null,null,null,null,null,null,null,null,null,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"]
[]
[]
[]
[]
[]
[]
["2025-04-01"]
[]
[]
[]
["記入方法"]
[]
[null,"提出者記入欄",null,null,null,null,null,"：","下図を参照し、健康保険の記号を入力してください。"]
[null,null,null,null,null,null,null,null,null,null,"健康保険の記号"]
[null,null,null,null,null,null,null,null,null,null,1234]
[]
[]
[null,"①被保険者等番号",null,null,null,null,null,"：","被保険者別に追番号を入力してください。"]
[null,"②氏名",null,null,null,null,null,"：","氏名は住民票に登録されているものと同じ氏名を入力してください。（ローマ字は不可）フリガナはカタカナで正確に"]
[null,null,null,null,null,null,null,null,"入力してください。"]
[null,"③生年月日",null,null,null,null,null,"：","生年月日は下図のように入力してください。"]
[null,null,null,null,null,null,null,null,null,null,"③",null,null,"1985-10-10"]
[null,null,null,null,null,null,null,null,null,null,"生年\n月日"]
[]
[]
[null,"④性別",null,null,null,null,null,"：","性別はプルダウンリストから選択してください。"]
[null,null,null,null,null,null,null,null,null,null,"④",null,null,"男"]
[null,null,null,null,null,null,null,null,null,null,"性別"]
[]
[]
[null,"⑤取得区分",null,null,null,null,null,"：","健康保険は「1. 健保・厚年」に該当するので記入不要です。"]
[null,"⑥個人番号",null,null,null,null,null,"：","本人確認を行ったうえで、個人番号（１２桁）を入力してください。基礎年金番号は入力しないでください。"]
[null,"⑦取得(該当)年月日",null,null,null,null,null,"：","適用事業所に使用されるに至った日（事実上の使用関係が発生した日）、その使用される事業所が適用事業所となった日"]
[null,null,null,null,null,null,null,null,"等を入力してください。"]
[null,"⑧被扶養者",null,null,null,null,null,"：","健康保険の被扶養者の有無については、プルダウンリストから選択してください。"]
[null,null,null,null,null,null,null,null,"「有」の場合は『被扶養者（異動）届』の届出が別途必要です。"]
[null,"⑨報酬月額",null,null,null,null,null,"：","「㋐（通貨）」は給料・手当等、名称を問わず労働の対償として金銭（通貨）で支払われる全ての合計額を入力してください。"]
[null,null,null,null,null,null,null,null,"　※1　臨時に支払うものや、３月を超える期間ごとに支払う賞与等は対象となりません。"]
[null,null,null,null,null,null,null,null,"　※2　週給の場合は、報酬額を7で割って得た額の30倍に相当する金額を入力してください。"]
[null,null,null,null,null,null,null,null,"　※3　実績によって報酬が変わる場合は、資格取得月の前月1ヵ月間に、同事業所内で同様の業務に携わっている従業員の"]
[null,null,null,null,null,null,null,null,"　　　 報酬の平均額を入力してください。"]
[null,null,null,null,null,null,null,null,"「㋑（現物）」は、報酬のうち食事・住宅・被服・定期券等、金銭（通貨）以外で支払われるものについて入力してください。"]
[null,null,null,null,null,null,null,null,"現物によるものの額は、厚生労働大臣によって定められた額（食事・住宅については都道府県ごとに定められた価格、その他"]
[null,null,null,null,null,null,null,null,"被服等は時価により算定した額）を入力してください。"]
[null,"⑪備考",null,null,null,null,null,"：","該当する場合にチェックしてください。"]
[null,null,null,null,null,null,null,null," 「二以上事業所勤務者の取得」に該当する場合は、資格取得日から10日以内に、被保険者が『被保険者所属選択・二以上"]
[null,null,null,null,null,null,null,null,"事業所勤務届』を提出する必要があります。"]
[null,null,null,null,null,null,null,null,"「短時間労働者の取得（特定適用事業所等）」は、短時間労働者に係る資格取得届を提出する場合にチェックしてください。"]
[null,null,null,null,null,null,null,null,"「退職後の継続再雇用者の取得」に該当する場合は、この届書とあわせて『被保険者資格喪失届』の提出が必要です。"]
[null,null,null,null,null,null,null,null,"被保険者が共済組合制度の適用を受ける二以上事業所勤務者であり、健康保険の徴収給付を行わない場合は、「その他」"]
[null,null,null,null,null,null,null,null,"にチェックし、（　）内に「他事業所で共済加入」と入力してください。"]
[null,"⑫住所",null,null,null,null,null,"：","住所は住民票住所を正確に入力してください。なお、日本国内に住民票（個人番号）を有していない等、住民票住所を記入"]
[null,null,null,null,null,null,null,null,"できない場合は、居所等を入力の上、「海外在住」「短期在留」「その他」のいずれか該当する理由にチェックし、"]
[null,null,null,null,null,null,null,null,"「その他」にチェックした場合は、その理由を入力してください。"]
[null,"⑬資格確認書",null,null,null,null,null,"：","資格確認書の発行が必要な場合（※）は「□発行が必要」にチェックしてください。"]
[null,"　発行要否",null,null,null,null,null,null,"※以下に該当する場合に限ります。"]
[null,null,null,null,null,null,null,null,"　・マイナンバーカードを取得していない者、マイナンバーカードの返納者"]
[null,null,null,null,null,null,null,null,"　・マイナンバーカードを保有しているが健康保険証利用登録していない者、利用登録解除を申請した者、利用登録解除者"]
[null,null,null,null,null,null,null,null,"　・マイナンバーカードの電子証明書の有効期限切れの者"]
[]
["添付書類"]
[null,"・60歳以上の方で退職後の継続再雇用の場合以下の書類が必要です。"]
[null,null,null,"ア.就業規則・退職辞令のコピー等退職日が確認できる書類、および継続して再雇用されたことが確認できる雇用契約書のコピー"]
[null,null,null,"イ.上記「ア」の書類が添付できない場合、事業主の証明書（退職日、再雇用日が記載されているもの）等"]
[]
["お知らせ"]
[null,"・この『被保険者資格取得届』を提出し、資格取得の確認および標準報酬月額が決定されると、『資格取得確認および標準報酬月額決定通知書』が"]
[null,"　事業所に送付されますので、事業主は通知内容を被保険者に通知してください。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["副",null,null,null,null,"健康保険　資格取得確認および標準報酬決定通知書"]
[]
[]
["令和",null,null,{"$f":"IF(D4=\"\",\"\",D4)","v":""},"年",{"$f":"IF(F4=\"\",\"\",F4)","v":""},"月",{"$f":"IF(H4=\"\",\"\",H4)","v":""},"日","提出"]
["提出者記入欄",null,null,null,"　届書記入の個人番号に誤りがないことを確認しました。"]
[null,"事業所\n所在地",null,null,null,"〒　　",{"$f":"IF(G6=\"\",\"\",G6)","v":""},"","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健康保険の記号"]
[null,null,null,null,null,{"$f":"IF(F7=\"\",\"\",F7)","v":""},"","","","","","","","","","","","","","","","","","","",null,null,{"$f":"IF(AB7=\"\",\"\",AB7)","v":""},"","","","",""]
[null,null,null,null,null,{"$f":"IF(F8=\"\",\"\",F8)","v":""},"","","","","","","","","","","","","","","","","","","",null,null,{"$f":"IF(AB8=\"\",\"\",AB8)","v":""},"","","","",""]
[null,"事業所\n名　称",null,null,null,{"$f":"IF(F9=\"\",\"\",F9)","v":""},"","","","","","","","","","","","","","","","","","","",null,null,{"$f":"IF(AB9=\"\",\"\",AB9)","v":""},"","","","",""]
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[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,{"$f":"IF(G22=\"\",\"\",G22)","v":""},"","","","","","円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
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[null,"取 得\n区 分",null,null,"　3. 共済出向",null,null,null,null,null,"個 人\n番 号",null,null,"＊＊＊＊＊＊＊＊＊＊＊＊",null,null,null,null,null,null,null,null,null,null,"取得(該当)\n年月日",null,null,{"$f":"IF(AB35=\"\",\"\",AB35)","v":""},"","","","","","","","","","被扶養者",null,null,{"$f":"IF(AO35=\"\",\"\",AO35)","v":""},"","",""]
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[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,{"$f":"IF(G37=\"\",\"\",G37)","v":""},"","","","","","円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
[null,"報 酬\n月 額",null,null,null,null,{"$f":"IF(G38=\"\",\"\",G38)","v":""},"","","","","",null,{"$f":"IF(N38=\"\",\"\",N38)","v":""},null,null,null,null,null,null,"","","","","備 考"]
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[null,"住民票\n住所",null,null,null,{"$f":"IF(F42=\"\",\"\",F42)","v":""},"","","","","","","","","","","","","","","","","","",true,null,"海外在住",null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,"入れてください。"]
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[null,"被保険者\n等番号",null,null,{"$f":"IF(E47=\"\",\"\",E47)","v":""},"","","","","","(ﾌﾘｶﾞﾅ)",null,"（氏）",{"$f":"IF(N47=\"\",\"\",N47)","v":""},"","","","","（名）",{"$f":"IF(T47=\"\",\"\",T47)","v":""},"","","","","生 年\n月 日",null,null,{"$f":"IF(AB47=\"\",\"\",AB47)","v":""},"","","","","","","","","","性別",null,null,{"$f":"IF(AO47=\"\",\"\",AO47)","v":""},"","",""]
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[null,"取 得\n区 分",null,null,"　3. 共済出向",null,null,null,null,null,"個 人\n番 号",null,null,"＊＊＊＊＊＊＊＊＊＊＊＊",null,null,null,null,null,null,null,null,null,null,"取得(該当)\n年月日",null,null,{"$f":"IF(AB50=\"\",\"\",AB50)","v":""},"","","","","","","","","","被扶養者",null,null,{"$f":"IF(AO50=\"\",\"\",AO50)","v":""},"","",""]
[null,null,null,null,"　4 .船保任継",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AB51=\"\",\"\",AB51)","v":""},"","","","","","","","","",null,null,null,{"$f":"IF(AO51=\"\",\"\",AO51)","v":""},"","",""]
[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,{"$f":"IF(G52=\"\",\"\",G52)","v":""},"","","","","","円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
[null,"報 酬\n月 額",null,null,null,null,{"$f":"IF(G53=\"\",\"\",G53)","v":""},"","","","","",null,{"$f":"IF(N53=\"\",\"\",N53)","v":""},null,null,null,null,null,null,"","","","","備 考"]
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[null,"住民票\n住所",null,null,null,{"$f":"IF(F57=\"\",\"\",F57)","v":""},"","","","","","","","","","","","","","","","","","",true,null,"海外在住",null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,"入れてください。"]
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[null,null,null,null,"　4 .船保任継",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AB66=\"\",\"\",AB66)","v":""},"","","","","","","","","",null,null,null,{"$f":"IF(AO66=\"\",\"\",AO66)","v":""},"","",""]
[null,"⑨　　　　　\n　 ",null,null,"㋐（通貨）",null,{"$f":"IF(G67=\"\",\"\",G67)","v":""},"","","","","","円","㋒（合計㋐＋㋑）",null,null,null,null,null,"円","⑩標準報酬月額",null,null,null,"⑪",null,null,"該当する項目にチェックを入れてください。"]
[null,"報 酬\n月 額",null,null,null,null,{"$f":"IF(G68=\"\",\"\",G68)","v":""},"","","","","",null,{"$f":"IF(N68=\"\",\"\",N68)","v":""},"","","","","","",{"$f":"IF(U68=\"\",\"\",U68)","v":""},"","","","備 考"]
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[null,"住民票\n住所",null,null,null,{"$f":"IF(F72=\"\",\"\",F72)","v":""},"","","","","","","","","","","","","","","","","","",true,null,"海外在住",null,null,null,null,null,null,null,"資格確認書\n発行要否",null,null,"入れてください。"]
[null,null,null,null,null,{"$f":"IF(F73=\"\",\"\",F73)","v":""},"","","","","","","","","","","","","","","","","","",true,null,"短期在留",null,null,null,null,null,null,null,null,null,null,null,null,null,"発行が必要"]
[null,null,null,null,null,{"$f":"IF(F74=\"\",\"\",F74)","v":""},"","","","","","","","","","","","","","","","","","",true,null,"その他（",null,{"$f":"IF(AC74=\"\",\"\",AC74)","v":""},"","","","","）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"提出された被保険者資格取得届にもとづき、うえのとおり資格取得の確認および標準報酬の決定"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"がなされたので通知します。"]
[]
[]
[]
[null,null,null,null,"この書類の保険料"]
[null,null,null,null,"は　　　　月分で"]
[null,null,null,null,"計算いたします",null,null,null,null,null,null,null,null,null,null,null,null,null,"令和　　　年　　　月　　　日",null,null,null,null,null,null,null,null,null,null,null,"東京金属事業健康保険組合理事長"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"この通知書を受け取りましたら、すみやかに確認された資格取得年月日および決定された標準報酬月額をそれぞれの被保険者に通知してください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,"この通知書は完結となった日から起算して２年間は、事業主が保存してください。"]
[]
[]
[]
[]
[]
[]
[null,null,null,"　この通知書でわからないことがあるときは当組合へお尋ねください。この処分に不服が"]
[null,null,null,"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"]
[null,null,null,"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"]
[null,null,null,"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"]
[null,null,null,"できます。"]
[null,null,null,"　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"]
[null,null,null,"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"]
[null,null,null,"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"]
[null,null,null,"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"]
[null,null,null,"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"]
[null,null,null,"たときは、提起することができなくなります。）"]
[null,null,null,"　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"]
[null,null,null,"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"]
[null,null,null,"査請求の決定を経なくても提起することができます。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,"お問い合わせ先：東京金属事業健康保険組合"]
[null,null,null,null,null,null,null,"<本　　部>　電話　０３－３８６６－２８６５（業務部　適用課）"]
[null,null,null,null,null,null,null,"<多摩支部>　電話　０３－５８３９－２４４１（業務課）"]

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[83000,93000,88,4]
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[146000,155000,150,12]
[155000,165000,160,13]
[165000,175000,170,14]
[175000,185000,180,15]
[185000,195000,190,16]
[195000,210000,200,17]
[210000,230000,220,18]
[230000,250000,240,19]
[250000,270000,260,20]
[270000,290000,280,21]
[290000,310000,300,22]
[310000,330000,320,23]
[330000,350000,340,24]
[350000,370000,360,25]
[370000,395000,380,26]
[395000,425000,410,27]
[425000,455000,440,28]
[455000,485000,470,29]
[485000,515000,500,30]
[515000,545000,530,31]
[545000,575000,560,32]
[575000,605000,590,33]
[605000,635000,620,34]
[635000,665000,650,35]
[665000,695000,680,36]
[695000,730000,710,37]
[730000,770000,750,38]
[770000,810000,790,39]
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[905000,955000,930,42]
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[1005000,1055000,1030,44]
[1055000,1115000,1090,45]
[1115000,1175000,1150,46]
[1175000,1235000,1210,47]
[1235000,1295000,1270,48]
[1295000,1355000,1330,49]
[1355000,null,1390,50]

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