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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日"]
["一般社団法人香川県中小企業退職金共済会　御中"]
[]
[]
["掛金納付月数通算同意書"]
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[]
[]
[null,null,null,"甲（旧事業所）共済契約番号",null,null,null,null,null,null,null,null,null,"-"]
[]
[]
[null,null,null,null,null,null,null,null,"住　　所"]
[]
[null,null,null,null,null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,"代表者名",null,null,null,null,null,null,null,null,null,null,null,null,"㊞"]
[]
[]
[]
[null,null,null,"乙（新事業所）共済契約番号",null,null,null,null,null,null,null,null,null,"-"]
[]
[]
[null,null,null,null,null,null,null,null,"住　　所"]
[]
[null,null,null,null,null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,"代表者名",null,null,null,null,null,null,null,null,null,null,null,null,"㊞"]
[]
[]
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[null,"　下記の被共済者より掛金納付月数を通算したい旨の申請があり、甲乙共に同意致しますので、"]
[null,"手続きをお願い致します。"]
["記"]
[null,"被共済者氏名"]
[]
[null,"甲掛金納付最終月",null,null,null,null,null,null,"年",null,"月分まで",null,null,"（",null,"／",null,"入金",null,"）"]
[]
[null,"乙掛金納付開始月",null,null,null,null,null,null,"年",null,"月分より",null,null,"（",null,"／",null,"入金",null,"）"]
[]
[]
[null,"※\t別紙に変更事項を入力いたしますので、必ず",null,null,null,null,null,null,null,null,null,"退職金共済証",null,null,null,null,"をご提出下さい。"]
[null,"※ 乙（新事業所）の共済契約番号を取得されてない方は空欄にしておいて下さい。"]
[]
[]
[null,null,null,null,null,"会　長",null,"副　会　長",null,null,null,"事務局長",null,"課　長",null,null,null,"担　当",null,"庶　務"]