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[{"$nulls":39},"　　　　　年　　　　　月　　　　　日"]
[]
["神戸市民間社会福祉施設職員退職手当共済事業"]
[]
["退職手当給付金請求書・退職届"]
[]
[]
["　社会福祉法人　神戸市社会福祉協議会　理事長　宛"]
["　"]
["施 設 番 号",{"$nulls":19},"法人名"]
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[{"$nulls":20},"施設名"]
[]
[{"$nulls":20},"施設長"]
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["加入者番号",{"$nulls":11},"（　フ　リ　ガ　ナ　）"]
[{"$nulls":12},"加　入　者　氏　名"]
[]
[]
[]
[]
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["　下記の退職理由に基づき、退職手当給付金を請求いたします。"]
[]
["就 職 年 月 日(西暦)",{"$nulls":18},"加 入 年 月 日(西暦)",{"$nulls":18},"退 職 年 月 日(西暦)"]
[{"$nulls":7},"年",null,null,null,"月",null,null,null,"日",{"$nulls":10},"年",null,null,null,"月",null,null,null,"日",{"$nulls":10},"年",null,null,null,"月",null,null,null,"日"]
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["退職理由"]
[{"$nulls":7},"（",{"$nulls":8},"）","1. 退職　　2. 解雇　　3. 死亡　　9.その他（",{"$nulls":24},"）"]
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["給　付\n種　類",{"$nulls":16},"１. 退職一時金　　　　2. 遺族一時金\n"]
[{"$nulls":7},"（",{"$nulls":8},"）"]
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["受 給 者 住 所",{"$nulls":4},"【現住所】"]
[{"$nulls":5},"郵便番号"]
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[{"$nulls":5},"住所"]
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[]
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[]
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[{"$nulls":5},"電話番号",{"$nulls":20},"受給者氏名"]
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[]
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[{"$nulls":55},"（2022.1）"]