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[]
[]
[null,null,null,null,null,"提出日","令和　　年　　月　　日"]
["加入者変更・申出書",null,null,null,"支部名",null,null,null,"コード"]
[null,null,null,null,null,null,null,null,"（　　　）"]
["裁判所共済組合　御中",null,null,null,"氏名"]
[]
[null,"現在加入中のグループ保険制度（新グループ保険、３大疾病保障保険、総合医療保険、",null,null,null,"（　）通中の（　）通"]
[null,"ライフプラン）に関し、下記のとおり変更・訂正がありましたので、通知いたします。"]
[]
["現在加入している保険",null,null,"現在の被保険者の内容"]
["該当する保険種類にレ点チェックしてください。",null,null,"加入内容の変更・訂正がある場合は、変更・訂正前の内容をご記入ください。"]
[null,null,null,"個人番号","家族\n区分","被保険者氏名",null,null,null,"性別","生年月日"]
[null,"新グループ保険（932-5948）",null,null,null,"（カタカナで記入してください）"]
[null,"３大疾病保障保険（939-87）",null,"（被保険者番号）",null,"セイ",null,"メイ",null,null,"年号","年","月","日"]
[null,"総合医療保険（900-95032）",null,null,"　　本人",null,null,null,null,"　　男性","　　昭和"]
[null,"ライフプラン（970-91826）",null,null,"　　配偶者",null,null,null,null,"　　女性","　　平成"]
[null,null,null,null,"　　こども",null,null,null,null,null,"　　令和","年","月","日"]
[null,null,null,null,"家族区分にレ点チェックしてください。"]
["変更・訂正内容（氏名・性別・生年月日・個人番号の変更・訂正）",null,null,null,null,null,null,"ライフプラン掛金引去の停止・再開"]
["内容を変更・訂正する場合、下記項目を完記ください。",null,null,null,null,null,null,"一般コースの掛金を停止・再開する場合、下記項目を完記ください。"]
["変更・訂正項目",null,"変更・訂正後内容",null,"変更年月日",null,null,null,"区分","復職後内容",null,"休職・復職"]
[null,null,null,null,"年","月","日",null,null,"払方","口数","開始年月"]
[null,"氏名（カタカナ）変更・訂正",null,null,"令和",null,null,null,"　　停止","月払",null,"令和"]
[null,"性別訂正",null,null,null,null,null,null,"（休職）",null,"口","　　　年　　月"]
[null,"生年月日訂正",null,null,null,null,null,null,"　　再開","賞与払",null,"令和"]
[null,"被保険者番号変更・訂正",null,null,"年","月","日",null,"（復職）",null,"口","　　　年　　月"]
["※該当する項目にレ点チェックください。",null,"※氏名はカタカナでご記入ください。",null,null,null,null,null,null,null,"※休職とは掛金払込中断を指します。"]
[null,null,null,null,null,null,null,null,null,null,"※復職とは掛金払込再開を指します。"]
[null,null,"＜備考欄＞その他、連絡事項があればご記入ください。"]