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["様式第１号の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,null,null,null,null,null,null,null,"　　　年　　　月　　　日伺"]
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[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"決定番号"]
[]
[]
["共済組合記載欄",null,null,"決　　　定",null,null,"償還回数",null,null,null,null,null,null,"回　",null,null,null,null,null,null,"据置期間",null,null,null,null,null,null,"月　",null,null,null,null,null,"決定額",null,null,null,null,null,null,"円　"]
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[null,null,null,null,null,null,"償還方法",null,null,null,null,null,null,"毎月・ボーナス併用",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"交付額",null,null,null,null,null,null,"円　"]
[null,null,null,null,null,null,"償還開始月",null,null,null,null,null,null,"　　　　　年　　　月",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"償還額",null,null,null,null,null,null,"毎月",null,null,null,null,null,null,"円　"]
[null,null,null,null,null,null,"利率",null,null,null,null,null,null,"　　　　　　　％",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ボーナス月",null,null,null,null,null,null,"円　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"普通・特別貸付申込書",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,null,null,null,null,null,null,null,null,null,"債務返済",null,null,null,null,null,"適用",null,null,null,"・","非適用"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"支援保険"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"団体信用\n生命保険",null,null,null,null,null,"加入",null,null,null,"・","非加入"]
[]
[]
["申込金額",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円　",null,null,null,"貸付種別",null,null,"普 通 貸 付",null,null,null,null,null,null,null,null,"(112)",null,null,null,null,null,"(115)"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特 別 貸 付",null,null,null,null,null,null,null,null,"(411)",null,null,null,null,null,"(421)",null,null,null,null,null,"(431)",null,null,null,null,null,"(441)",null,null,null,null,null,"(451)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療",null,null,null,null,null,"入学",null,null,null,null,null,"修学",null,null,null,null,null,"結婚",null,null,null,null,null,"葬祭"]
["償還方法\n及び回数",null,null,null,null,null,"毎月",null,null,"・","ボーナス併用",null,null,null,null,null,null,null,null,null,null,"回　",null,null,"借受希望日",null,null,null,null,null,null,null,"令和",null,null,"",null,null,null,"年",null,"",null,null,"月",null,"",null,null,"日",null,"据　置",null,null,null,null,null,null,null,null,null,null,null,"月"]
["申　　込　　人",null,null,"所 属 所",null,null,null,null,null,null,null,null,null,null,null,null,null,"組合員等\n記号・番号",null,null,null,null,null,"北都市",null,null,null,"（",null,"",null,"）",null,"第",null,null,null,null,null,null,null,"号",null,"資格取得日",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,null,"日"]
[null,null,null,"給料月額",null,null,null,null,null,null,null,null,null,null,null,null,null,"級",null,null,null,null,null,null,"号",null,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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,"貸付申込月の\n正規の勤務時間(※)",null,null,null,null,null,null,null,null,null,null,"時間",null,null,"貸付申込月の休業予定\n(申請)の勤務時間(※)",null,null,null,null,null,null,null,null,null,null,null,null,"時間"]
[null,null,null,"フリガナ",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,null,null,"生年月日",null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,"年　齢",null,null,null,null,null,null,"才"]
[null,null,null,"氏　　名"]
[null,null,null,"家族に係る貸付事由対象者の氏名・生年月日・年齢・続柄"]
[null,null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,null,null,null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日",null,"年　齢",null,null,null,null,null,"才",null,"続　柄"]
[null,null,null,"氏　　名"]
["振込先金融機関（本人名義）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"共済組合の借入状況"]
["銀行コード",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※記入しない\n　で下さい。",null,null,null,null,null,null,null,null,"貸付種別",null,null,null,null,null,null,"貸付事由",null,null,null,null,null,null,"貸　付　番　号",null,null,null,null,null,null,null,null,null,null,null,"残　　高"]
["支店コード",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"号",null,"",null,null,null,null,null,null,null,"円"]
["金融機関名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"銀行",null,null,"金庫",null,null,"組合",null,null,"",null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"号",null,"",null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"号",null,"",null,null,null,null,null,null,null,"円"]
["本支店名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本店",null,null,null,null,"支店",null,null,null,"",null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"号",null,"",null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"号",null,null,null,null,null,null,null,null,null,"円"]
["口座番号\n普通預金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"号",null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"号",null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,"上記のとおり北海道都市職員共済組合貸付規則に基づき貸付を受けたいので申し込みます。"]
[null,null,null,"　北海道都市職員共済組合理事長　様"]
[null,null,null,null,null,"令和",null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"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,"申込人　　　　　　　　　　　　　　　　　　　　　　　",null,null,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"]
[null,null,null,"※申込人自ら署名する場合は、押印は不要です。"]
[null,null,null,"北海道都市職員共済組合貸付規則第８条第５項の規定に基づき、上記の記載事項及び関係書類を確認した結果、"]
[null,null,null,"上記申し込みは事実に相違なく、適正なものであることを認めます。"]
[]
[null,null,null,null,null,"令和",null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日"]
[null,null,null,"　　　北海道都市職員共済組合理事長　殿",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　所属所長　　　　　　　　　　　","所属所長　　　　　　　　　　　"]
[null,"注１ 費用等の明細書は必ず添付してください。"]
[null,"注２ 記載事項に誤りがあった場合は、訂正印を押印してください。"]
[null,"注３「給料月額」について、令和４年１０月１日以降組合員適用となった短時間勤務職員においては、「報酬月額」と読み替えて記入"]
[null,"　　してください。（（　級　号）の記入は不要です。）"]
[null,"注４ 「貸付申込月の正規の勤務時間」及び「貸付申込月の休業予定（申請）時間」は、育児短時間勤務、育児部分休業、修学部分休"]
[null,"　　業、高齢者部分休業、その他病気休暇等により、条例の規定に基づき給料（または報酬）の一部が減額されている場合に記入し"]
[null,"    てください。"]