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["扶養状況確認票　兼　必要書類チェック票(現在または直近まで外国在住の方)"]
[]
["◆該当する□欄に☑・記入し、回答に応じた必要書類を添付のうえご提出ください。(必ず添付した必要書類のチェック欄に☑してください)"]
["◆この用紙は、被扶養者認定基準を満たしているかを判断する書類ですので、必ず事実に基づいてご記入ください。"]
["◆未記入や不足書類がある場合、差し戻し等で審査に時間を要します。",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,null,null,null,null,null,null,"氏名コード"]
["◆必要に応じて内容の問合せや、追加書類を求める場合があります。"]
[]
["1.基本情報",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
["氏名",null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,"年齢",null,null,"職業",null,null,null,null,null,"※全員必須"]
[null,null,null,null,null,null,null,null,null,null,null,null,"被保険者\n(本人)",null,null,null,null,null,"歳",null,null,null,null,null,null,null,null,"次の➊～➌のいずれか一つ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➊","日本の住民票の原本"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"歳",null,null,null,null,null,null,null,null,null,"(世帯全員分、続柄・筆頭者記載のもの)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➋","日本の戸籍謄本"]
["　居住区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➌","外国の戸籍謄本にあたる書類"]
[null,null,"1)同居"]
[null,null,"2)単身赴任"]
[null,null,"3)別居",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※3)別居の場合のみ"]
[null,null,null,null,"A)母国(自国)に残留",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"別居家族状況記入書(健保HPより入手)"]
[null,null,null,null,"B)第三国",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"仕送り証明書の写し　直近3か月分"]
["2.居住国について",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
[null,null,"1)日本国内に居住",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在留カードの写し(外国籍の方のみ)"]
[null,null,null,"⇒","日本の住民登録日　(",null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日)",null,null,null,null,null,"※パスポートに指定書がついている場合はその写しも併せて"]
[null,null,"2)外国に居住",null,null,null,"⇒","国名 (",null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,"A)被保険者(あなた)の海外出向先に居住している"]
[null,null,null,null,"B)留学している",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"査証(写)、在学証明書(原本)、入学証明書(写)"]
[null,null,null,null,"C)その他　↓詳細に記入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"査証(写)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜状況によって必要書類が異なりますので、\n　 健康保険組合までご確認ください。"]
["3.扶養申請の理由",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事由発生日"]
[null,null,"1)被保険者(あなた)の入社",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 入社日"]
[null,null,"2)被保険者(あなた)の海外出向への帯同",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 日本の住民登録日",null,null,null,null,null,null,null,null,"日本の住民票の原本(上記➊の書類)"]
[null,null,"3)退職　(退職日：",null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"," 退職日の翌日",null,null,null,null,null,null,null,null,"退職証明書"]
[null,null,"4)婚姻　(婚姻日：",null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"," 婚姻日",null,null,null,null,null,null,null,null,"婚姻証明書写し(❷で代替可能)"]
[null,null,"5)出生：配偶者の扶養状況の確認",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 出生日",null,null,null,null,null,null,null,null,"出生証明書写し(❷で代替可能)"]
[null,null,null,null,"1)健康保険の扶養に入っている"]
[null,null,null,null,"2)健康保険の扶養に入っていない(配偶者が自身で加入中)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"配偶者がムラタ健保に加入している場合",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,"→2)の場合は、夫婦双方の育休取得有無・見込収入をご記入ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名コード："]
[null,null,null,null,null,null,null,null,"育児休業(産後休暇含む)取得予定",null,null,null,null,null,null,null,null,null,null,null,"今後1年間の見込収入"]
[null,null,null,null,"被保険者",null,null,null,null,"なし",null,null,null,null,null,null,null,null,null,null,"収入種別に○➜(",null,null,null,null,"給与",null,"・","自営業",null,"・","育休給付金",null,null,null,"・","その他",null,")",null,null,null,null,null,null,false]
[null,null,null,null,null,null,null,null,null,"あり ➜ 期間 (",null,null,null,null,null,"年",null,null,"ヶ月)",null,"収入額 ➜ (",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円／年)",null,null,null,null,null,null,null,null,null,false]
[null,null,null,null,"配偶者",null,null,null,null,"なし",null,null,null,null,null,null,null,null,null,null,"収入種別に○➜(",null,null,null,null,"給与",null,"・","自営業",null,"・","育休給付金",null,null,null,"・","その他",null,")",null,null,null,null,null,null,false]
[null,null,null,null,null,null,null,null,null,"あり ➜ 期間 (",null,null,null,null,null,"年",null,null,"ヶ月)",null,"収入額 ➜ (",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円／年)",null,null,null,null,null,null,null,null,null,false]
[null,null,"※後日、事実との大幅な相違が確認できた際には、遡って削除させて頂く場合があります。"]
[null,null,"6)その他　↓扶養申請するに至った理由をできるだけ詳細に記入"]
[null,null,"＜理由＞",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜状況によって必要書類が異なりますので、\n　 健康保険組合までご確認ください。"]
["4.これまで加入していた(している)健康保険　※出生の場合、記入不要"]
["●現地で加入していた(している)健康保険の種類(民間保険、地域保険、国保等)"]
[]
["●現地で加入していた(している)健康保険の資格を喪失していますか？"]
[null,null,"資格を喪失している ⇒ 喪失日　(",null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日)"]
[null,null,"資格を喪失していない"]
["➜16歳以上の方のみ2ページ目につづきます\n（16歳未満の方は1ページ目のみご提出ください）"]
["5.対象者の収入について　※扶養申請前と扶養申請後の状況について回答ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
[null,null,null,null,null,null,null,null,null,null,null,null,"…各ケースの事由発生日については、\n　1ページ目の「2.扶養申請理由」をご覧ください"]
[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,"※全員必須(A～C共通)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"次の【1】～【5】 のいずれか一つ"]
["いずれか\n✔↓",null,null,null,"事由発生前\nの収入",null,null,null,null,"事由発生後\nの収入見込",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【1】",null,"納税証明書"]
[null,null,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,"確定申告書(年末清算書)"]
["A",null,null,null,"無",null,null,null,null,"無",null,null,null,null,"…\n","収入無しであることを、右記のいずれかの書類で確認いたします",null,null,null,null,null,null,null,null,null,"　","【3】",null,"無収入証明書(無所得証明書)"]
[null,null,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,"【1】～【3】に準ずるもの(公的機関発行のもの)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"≪AorBで日本国内居住の方のみ≫"]
[null,null,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,"無収入申立書(村田健保HPよりDL)"]
[]
["B",null,null,null,"有",null,null,null,null,"無",null,null,null,null,"収入が無くなった理由",null,null,null,null,null,null,null,null,null,null,"↑【1】～【5】の書類に加えて↓該当する書類"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1)休職",null,null,null,null,null,null,null,null,null,"休職証明書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2)退職",null,null,null,null,null,null,null,null,null,"退職証明書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"3)その他 (",null,null,null,null,null,null,")","➜",null,"状況によって必要書類が異なりますので、\n健康保険組合までご確認ください。"]
["C",null,null,null,"有",null,null,null,null,"有",null,null,null,null,null,null,null,null,null,null,null,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]
[]
[]
[]
["事由発生後から1年間の見込収入",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】～【5】の書類に加えて↓該当する書類"]
[null,"※下記いずれかに必ずチェックを入れてください"]
[null,null,null,null,"給与収入のみ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜","1)に金額を記入、2)～7)は記入不要",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,null,"給与収入以外の収入 または 給与収入＋給与収入以外の収入 あり",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜","1)～7)の\"全て\"に金額を記入(収入無の項目は0円)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
["1)給与(パート・アルバイト含む)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"月額",null,null,null,null,null,null,null,null,"円",null,null,"労働条件通知書 等"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※労働条件通知書等を提出できない場合は\n　　「給与支払証明書：直近3か月分」　を提出"]
["2)年金(老齢・障害・遺族・企業年金等)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,null,null,null,null,null,null,null,"円",null,null,"年金額が分かるものの写し"]
["3)自営業収入(農・商・漁・販売・他)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,null,null,null,null,null,null,null,"円",null,null,"収入額が分かるものの写し"]
["4)家賃・不動産等の収入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,null,null,null,null,null,null,null,"円"]
["5)株の配当金・利子等の収入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,null,null,null,null,null,null,null,"円"]
["6)その他継続性のある収入(内容：",null,null,null,null,null,null,null,null,null,null,null,null,null,")","月額",null,null,null,null,null,null,null,null,"円"]
["※個人情報の保護について　：　この情報は健康保険の事業のみの利用とし、その他の目的には使用致しません。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"R8.5 "]

{"sheet":"外国（記入例）R8.5","index":1,"n_rows":83,"n_cols":46,"rows_kept":83,"cut":false,"hidden":false,"merged":[[81,9,81,13],[81,15,81,16],[81,17,81,23],[82,38,82,39],[78,15,78,16],[78,17,78,23],[78,25,81,26],[78,27,81,39],[79,15,79,16],[79,17,79,23],[80,15,80,16],[80,17,80,23],[75,27,75,39],[76,27,76,39],[77,15,77,16],[77,17,77,23],[77,25,77,26],[77,27,77,39],[71,0,71,24],[71,25,71,39],[72,1,72,13],[73,2,73,3],[74,2,74,3],[75,0,76,14],[75,15,76,16],[75,17,76,23],[75,24,76,24],[75,25,76,26],[67,0,70,1],[67,2,70,3],[67,4,70,8],[67,9,70,13],[67,14,70,24],[67,25,70,39],[64,25,64,26],[64,27,64,39],[65,15,65,16],[65,25,65,26],[65,27,65,39],[66,15,66,16],[66,20,66,23],[66,25,66,26],[66,27,66,39],[58,26,58,27],[59,26,59,27],[61,26,61,27],[63,0,66,1],[63,2,66,3],[63,4,66,8],[63,9,66,13],[63,14,63,24],[63,25,63,39],[64,15,64,16],[58,0,62,1],[58,2,62,3],[58,4,62,8],[58,9,62,13],[58,14,62,14],[58,15,62,24],[52,0,52,24],[52,25,52,39],[53,12,55,24],[55,25,55,26],[55,27,55,39],[56,0,57,3],[56,4,57,8],[56,9,57,13],[56,26,56,27],[57,26,57,27],[49,0,49,1],[49,11,49,14],[49,16,49,18],[49,20,49,22],[50,0,50,1],[51,0,51,39],[44,0,44,1],[44,2,44,24],[44,25,44,39],[45,0,45,24],[45,25,45,39],[47,0,47,24],[40,36,40,37],[41,13,41,14],[41,16,41,17],[41,24,41,34],[43,0,43,1],[43,25,43,26],[39,16,39,17],[39,24,39,34],[40,4,41,7],[40,25,40,26],[40,28,40,29],[40,31,40,34],[36,3,36,21],[36,29,36,38],[37,4,37,7],[37,20,37,38],[38,4,39,7],[38,25,38,26],[38,28,38,29],[38,31,38,34],[38,36,38,37],[39,13,39,14],[33,0,33,1],[33,18,33,24],[33,25,33,26],[33,27,33,39],[34,2,34,3],[35,2,35,3],[31,27,31,39],[32,0,32,1],[32,8,32,10],[32,12,32,13],[32,15,32,16],[32,18,32,24],[32,25,32,26],[30,0,30,1],[30,18,30,24],[30,25,30,26],[30,27,30,39],[31,0,31,1],[31,8,31,10],[31,12,31,13],[31,15,31,16],[31,18,31,24],[31,25,31,26],[26,4,26,24],[26,25,26,39],[27,0,27,24],[27,25,27,39],[28,18,28,24],[29,0,29,1],[29,18,29,24],[24,25,24,26],[24,27,24,39],[25,2,25,3],[25,4,25,24],[25,25,25,26],[25,27,25,39],[22,0,22,1],[22,9,22,20],[23,2,23,3],[23,4,23,24],[24,2,24,3],[24,4,24,24],[20,0,20,1],[20,25,20,26],[20,27,20,39],[21,10,21,12],[21,14,21,16],[21,18,21,20],[21,27,21,39],[17,2,17,3],[17,25,17,26],[18,2,18,3],[18,25,18,26],[19,0,19,24],[19,25,19,39],[13,0,13,24],[14,0,14,1],[14,2,14,17],[15,0,15,1],[15,2,15,17],[16,0,16,1],[16,2,16,17],[9,25,9,26],[11,0,12,11],[11,12,12,15],[11,16,12,17],[11,18,12,18],[11,19,12,24],[8,0,8,11],[8,12,8,15],[8,16,8,18],[8,19,8,24],[8,25,8,39],[9,0,10,11],[9,12,10,15],[9,16,10,17],[9,18,10,18],[9,19,10,24],[0,0,0,39],[2,0,2,39],[3,0,3,33],[4,34,4,39],[5,34,6,39],[7,0,7,24],[7,25,7,39]]}
["扶養状況確認票　兼　必要書類チェック票(現在または直近まで外国在住の方)"]
[]
["◆該当する□欄に☑・記入し、回答に応じた必要書類を添付のうえご提出ください。(必ず添付した必要書類のチェック欄に☑してください)"]
["◆この用紙は、被扶養者認定基準を満たしているかを判断する書類ですので、必ず事実に基づいてご記入ください。"]
["◆未記入や不足書類がある場合、差し戻し等で審査に時間を要します。",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,null,null,null,null,null,null,"氏名コード"]
["◆必要に応じて内容の問合せや、追加書類を求める場合があります。",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,"MM00000"]
[]
["1.基本情報",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
["氏名",null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,"年齢",null,null,"職業",null,null,null,null,null,"※全員必須"]
["MURATA TARO",null,null,null,null,null,null,null,null,null,null,null,"被保険者\n(本人)",null,null,null,30,null,"歳",null,null,null,null,null,null,null,null,"次の➊～➌のいずれか一つ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➊","日本の住民票の原本"]
["MURATA HANA",null,null,null,null,null,null,null,null,null,null,null,"妻",null,null,null,30,null,"歳","無職",null,null,null,null,null,null,null,null,"(世帯全員分、続柄・筆頭者記載のもの)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➋","日本の戸籍謄本"]
["　居住区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➌","外国の戸籍謄本にあたる書類"]
[null,null,"1)同居"]
[null,null,"2)単身赴任"]
[null,null,"3)別居",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※3)別居の場合のみ"]
[null,null,null,null,"A)母国(自国)に残留",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"別居家族状況記入書(健保HPより入手)"]
[null,null,null,null,"B)第三国",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"仕送り証明書の写し　直近3か月分"]
["2.居住国について",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
[null,null,"1)日本国内に居住",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在留カードの写し(外国籍の方のみ)"]
[null,null,null,"⇒","日本の住民登録日　(",null,null,null,null,null,"令和8",null,null,"年",4,null,null,"月",1,null,null,"日)",null,null,null,null,null,"※パスポートに指定書がついている場合はその写しも併せて"]
[null,null,"2)外国に居住",null,null,null,"⇒","国名 (",null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,"A)被保険者(あなた)の海外出向先に居住している"]
[null,null,null,null,"B)留学している",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"査証(写)、在学証明書(原本)、入学証明書(写)"]
[null,null,null,null,"C)その他　↓詳細に記入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"査証(写)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜状況によって必要書類が異なりますので、\n　 健康保険組合までご確認ください。"]
["3.扶養申請の理由",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事由発生日"]
[null,null,"1)被保険者(あなた)の入社",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 入社日"]
[null,null,"2)被保険者(あなた)の海外出向への帯同",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 日本の住民登録日",null,null,null,null,null,null,null,null,"日本の住民票の原本(上記➊の書類)"]
[null,null,"3)退職　(退職日：",null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"," 退職日の翌日",null,null,null,null,null,null,null,null,"退職証明書"]
[null,null,"4)婚姻　(婚姻日：",null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"," 婚姻日",null,null,null,null,null,null,null,null,"婚姻証明書写し(❷で代替可能)"]
[null,null,"5)出生：配偶者の扶養状況の確認",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 出生日",null,null,null,null,null,null,null,null,"出生証明書写し(❷で代替可能)"]
[null,null,null,null,"1)健康保険の扶養に入っている"]
[null,null,null,null,"2)健康保険の扶養に入っていない(配偶者が自身で加入中)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"配偶者がムラタ健保に加入している場合",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,"→2)の場合は、夫婦双方の育休取得有無・見込収入をご記入ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名コード："]
[null,null,null,null,null,null,null,null,"育児休業(産後休暇含む)取得予定",null,null,null,null,null,null,null,null,null,null,null,"今後1年間の見込収入"]
[null,null,null,null,"被保険者",null,null,null,null,"なし",null,null,null,null,null,null,null,null,null,null,"収入種別に○➜(",null,null,null,null,"給与",null,"・","自営業",null,"・","育休給付金",null,null,null,"・","その他",null,")",null,null,null,null,null,null,false]
[null,null,null,null,null,null,null,null,null,"あり ➜ 期間 (",null,null,null,null,null,"年",null,null,"ヶ月)",null,"収入額 ➜ (",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円／年)",null,null,null,null,null,null,null,null,null,false]
[null,null,null,null,"配偶者",null,null,null,null,"なし",null,null,null,null,null,null,null,null,null,null,"収入種別に○➜(",null,null,null,null,"給与",null,"・","自営業",null,"・","育休給付金",null,null,null,"・","その他",null,")",null,null,null,null,null,null,false]
[null,null,null,null,null,null,null,null,null,"あり ➜ 期間 (",null,null,null,null,null,"年",null,null,"ヶ月)",null,"収入額 ➜ (",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円／年)",null,null,null,null,null,null,null,null,null,false]
[null,null,"※後日、事実との大幅な相違が確認できた際には、遡って削除させて頂く場合があります。"]
[null,null,"6)その他　↓扶養申請するに至った理由をできるだけ詳細に記入"]
[null,null,"＜理由＞",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜状況によって必要書類が異なりますので、\n　 健康保険組合までご確認ください。"]
["4.これまで加入していた(している)健康保険　※出生の場合、記入不要"]
["●現地で加入していた(している)健康保険の種類(民間保険、地域保険、国保等)"]
["○○国の国営医療保険"]
["●現地で加入していた(している)健康保険の資格を喪失していますか？"]
[null,null,"資格を喪失している ⇒ 喪失日　(",null,null,null,null,null,null,null,null,"令和8",null,null,null,"年",4,null,null,"月",1,null,null,"日)"]
[null,null,"資格を喪失していない"]
["➜16歳以上の方のみ2ページ目につづきます\n（16歳未満の方は1ページ目のみご提出ください）"]
["5.対象者の収入について　※扶養申請前と扶養申請後の状況について回答ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要書類"]
[null,null,null,null,null,null,null,null,null,null,null,null,"…各ケースの事由発生日については、\n　1ページ目の「2.扶養申請理由」をご覧ください"]
[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,"※全員必須(A～C共通)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"次の【1】～【5】 のいずれか一つ"]
["いずれか\n✔↓",null,null,null,"事由発生前\nの収入",null,null,null,null,"事由発生後\nの収入見込",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【1】",null,"納税証明書"]
[null,null,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,"確定申告書(年末清算書)"]
["A",null,null,null,"無",null,null,null,null,"無",null,null,null,null,"…\n","収入無しであることを、右記のいずれかの書類で確認いたします",null,null,null,null,null,null,null,null,null,"　","【3】",null,"無収入証明書(無所得証明書)"]
[null,null,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,"【1】～【3】に準ずるもの(公的機関発行のもの)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"≪AorBで日本国内居住の方のみ≫"]
[null,null,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,"無収入申立書(村田健保HPよりDL)"]
[]
["B",null,null,null,"有",null,null,null,null,"無",null,null,null,null,"収入が無くなった理由",null,null,null,null,null,null,null,null,null,null,"↑【1】～【5】の書類に加えて↓該当する書類"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1)休職",null,null,null,null,null,null,null,null,null,"休職証明書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2)退職",null,null,null,null,null,null,null,null,null,"退職証明書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"3)その他 (",null,null,null,null,null,null,")","➜",null,"状況によって必要書類が異なりますので、\n健康保険組合までご確認ください。"]
["C",null,null,null,"有",null,null,null,null,"有",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[]
[]
[]
["事由発生後から1年間の見込収入",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】～【5】の書類に加えて↓該当する書類"]
[null,"※下記いずれかに必ずチェックを入れてください"]
[null,null,null,null,"給与収入のみ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜","1)に金額を記入、2)～7)は記入不要",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,null,"給与収入以外の収入 または 給与収入＋給与収入以外の収入 あり",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"➜","1)～7)の\"全て\"に金額を記入(収入無の項目は0円)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
["1)給与(パート・アルバイト含む)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"月額",null,0,null,null,null,null,null,null,"円",null,null,"労働条件通知書 等"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※労働条件通知書等を提出できない場合は\n　　「給与支払証明書：直近3か月分」　を提出"]
["2)年金(老齢・障害・遺族・企業年金等)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,0,null,null,null,null,null,null,"円",null,null,"年金額が分かるものの写し"]
["3)自営業収入(農・商・漁・販売・他)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,0,null,null,null,null,null,null,"円",null,null,"収入額が分かるものの写し"]
["4)家賃・不動産等の収入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,500000,null,null,null,null,null,null,"円"]
["5)株の配当金・利子等の収入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年額",null,0,null,null,null,null,null,null,"円"]
["6)その他継続性のある収入(内容：",null,null,null,null,null,null,null,null,null,null,null,null,null,")","月額",null,0,null,null,null,null,null,null,"円"]
["※個人情報の保護について　：　この情報は健康保険の事業のみの利用とし、その他の目的には使用致しません。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"R8.5 "]