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[null,null,null,null,null,null,null,null,null,null,"保険・共済等「保障見直し診断申込書」",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2023]
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[null,null,null,null,null,null,null,null,null,null,"※【「保障見直し診断」のご案内】をご確認の上ご記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2020]
[null,null,null,null,null,null,null,null,null,null,"※　　　　　 　　　　はプルダウンから選んでください。選択肢に該当するものがない場合はダブルクリックすることで直接入力することができます。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2019]
[null,null,null,null,null,null,null,null,null,null,"　また、　    は入力必須項目です。必ずご入力ください。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2018]
[null,null,null,null,null,null,null,null,null,null,"※　　　　　　　　　は複数選択可能です。クリックすることでチェックが入ります。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2017]
[null,null,null,null,null,null,null,null,null,null,"※所属組合ごとの申込者情報をコンポーズサービスと所属組合で共有させていただきます。なお、本申込みにより取得した個人情報は、コンポーズサービス\n　への連絡や診断結果の受領など、本診断に関連することにのみ利用します。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2016]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2015]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申込日",null,null,null,null,"年",null,null,"月",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2014]
[null,null,null,null,null,null,null,null,null,null,"●相談者",null,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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2013]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2012]
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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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2010]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,null,null,null,null,"年",null,"月",null,"日",null,"日中の連絡先",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2009]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"＠",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2007]
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[null,null,null,null,null,null,null,null,null,null,"●住所",null,null,null,null,"都道府県",null,null,null,null,null,null,null,null,null,"市区町村郡",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2005]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"持ち家",null,null,null,null,null,"団体信用生命保険へのご加入",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2003]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2002]
[null,null,null,null,null,null,null,null,null,null,"●配偶者様",null,null,null,null,"配偶者",null,null,null,null,null,"年齢",null,null,null,"歳",null,"生年月日",null,null,null,null,null,"年",null,"月",null,"日",null,"就労状況",null,null,null,null,null,null,"雇用形態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2001]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電機連合の組合員ですか？",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"収入割合",null,null,null,"本人：配偶者＝",null,null,null,null,null,null,"：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1999]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※お子様が4名以上の場合には\nご年齢を【備考欄】にご記載ください。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1998]
[null,null,null,null,null,null,null,null,null,null,"●子供",null,null,null,null,"有無",null,null,null,null,"人数",null,null,null,"名",null,"第1子",null,null,null,"歳",null,"第2子",null,null,null,"歳",null,"第3子",null,null,null,"歳",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1997]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1996]
[null,null,null,null,null,null,null,null,null,null,"●その他扶養者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1995]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1994]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1993]
[null,null,null,null,null,null,null,null,null,null,"●ご希望の回答方法",null,null,null,null,null,null,null,null,null,null,null,null,"ご希望の面談方法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1992]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1991]
[null,null,null,null,null,null,null,null,null,null,"現在加入の保険・共済",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1990]
[null,null,null,null,null,null,null,null,null,null,"団体生命・団体医療・生命・医療・傷害・グループ・個人年金保険など　※火災・自動車保険(共済)は見直し診断対象外",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1989]
[null,null,null,null,null,null,null,null,null,null,"加入者",null,null,null,null,"加入日\n(西暦)",null,null,null,null,null,null,"見直しする保険･共済の会社名と商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険料(掛金)\n月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1988]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1987]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",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,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,1986]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",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,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,1985]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",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,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,1984]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",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,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,1983]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",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,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,1982]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←クリックすると選択しているセルの一行下に入力欄が追加されます。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険料(掛金)総額",null,null,null,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,1981]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←クリックすると選択しているセルのある行が削除されます。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1980]
[null,null,null,null,null,null,null,null,null,null,"保障見直し診断に際しての\nご要望点",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1979]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,false,false,false,false,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1978]
[null,null,null,null,null,null,null,null,null,null,"▼【備考欄】その他ご要望等ございましたらご記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1977]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1976]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1975]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1974]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1973]
[null,null,null,null,null,null,null,null,null,null,"正確な診断をするために、見直しする保険･共済の詳細内容がわかる",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972]
[null,null,null,null,null,null,null,null,null,null,"「保険証券(共済証書)」「ご契約内容のお知らせ等」更新時の「提案書」などのコピーを一式",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1971]
[null,null,null,null,null,null,null,null,null,null,"メールまたは郵送（PDF・スマートフォンで撮影した写真データ※も可）にて必ずご提出ください。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970]
[null,null,null,null,null,null,null,null,null,null,"※「保障の見直し」に関する書類のみを鮮明に撮影してください。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1969]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1968]
[null,null,null,null,null,null,null,null,null,null,"個人情報につき取扱い注意　※FAX使用不可",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1967]
[null,null,null,null,null,null,null,null,null,null,"＜組合記入欄＞",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1966]
[null,null,null,null,null,null,null,null,null,null,"組合名",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貴労組や会社で加入できる共済(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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1965]
[null,null,null,null,null,null,null,null,null,null,"支部名",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こくみん共済coopの団体生命共済の取り組み",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1964]
[null,null,null,null,null,null,null,null,null,null,"共済担当者名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※①②が「有」の場合、保障額と保険料（掛金）が分かる\n　該当資料をコンポーズサービスにご提供ください。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1963]
[null,null,null,null,null,null,null,null,null,null,"組合TEL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962]
[null,null,null,null,null,null,null,null,null,null,"担当者E-mail",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※東京地協・千葉地協加盟組合以外はマックスへ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1961]
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[null,"保険・共済等「保障見直し診断申込書」"]
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[null,"※【「保障見直し診断」のご案内】をご確認の上ご記入ください。"]
[null,"※　　　　　　　 はプルダウンから選んでください。選択肢に該当するものがない場合はダブルクリックすることで直接入力することができます。"]
[null,"　また、　　　は入力必須項目です。必ずご入力ください。"]
[null,"※所属組合ごとの申込者情報をコンポーズサービスと所属組合で共有させていただきます。"]
[null,"※本申込みにより取得した個人情報は、電機連合福祉共済センター総合代理店コンポーズサービスへの連絡や診断結果の受領など、診断に関連することに\n  のみ利用します。"]
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[null,null,null,null,null,null,"持ち家",null,null,null,null,null,"団体信用生命保険へのご加入は"]
[]
[null,"●配偶者様",null,null,null,null,"配偶者",null,null,null,null,null,null,"ご年齢",null,null,null,null,"歳",null,"生年月日",null,null,null,null,null,"年",null,"月",null,"日",null,"電機連合の組合員ですか？"]
[]
[null,null,null,null,null,null,"就労状況",null,null,null,null,null,null,"雇用形態",null,null,null,null,null,null,null,null,null,"収入割合",null,null,null,"ご本人：配偶者＝",null,null,null,null,null,null,null,null,"："]
[]
[null,"●お子様",null,null,null,null,"有無",null,null,null,null,"人数",null,null,null,"名",null,"第１子",null,null,null,null,null,"歳",null,null,"第２子",null,null,null,null,null,"歳",null,null,"第３子",null,null,null,null,null,"歳"]
[null,null,null,null,null,null,"※お子様が3名以上の場合には年齢と生年月日を【備考欄】にご記載ください。",null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日生",null,null,null,null,"年",null,"月",null,"日生",null,null,null,null,"年",null,"月",null,"日生"]
[]
[null,"●その他扶養者",null,null,null,null,null,null,"有無",null,null,null,null,"扶養者構成"]
[]
[null,"●回答方法について",null,null,null,null,null,null,null,"ご希望の回答方法",null,null,null,null,null,null,null,null,null,null,"面談をご希望されますか？",null,null,null,null,null,null,null,null,null,null,null,null,null,"ご希望の面談方法"]
[]
[null,"現在加入の保険・共済"]
[null,"団体生命保険・団体医療保険・生命保険・医療保険・傷害保険・グループ保険・個人年金保険など"]
[null,"ご加入者様",null,null,null,"加入日\n(西暦)",null,null,null,null,null,null,"見直しする保険･共済の会社名と商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険料(掛金)\n月額"]
[]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,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,"保険料(掛金)総額",null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[null,"▼【備考欄】その他ご要望等ございましたらご記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保障見直し診断に際してのご要望点"]
[]
[]
[]
[]
[null,"正確な診断をするために、見直しする保険･共済の詳細内容がわかる"]
[null,"「保険証券(共済証書)」「ご契約内容のお知らせ等」更新時の「提案書」などのコピーを一式"]
[null,"メールまたは郵送（PDF・スマートフォンで撮影した写真データ※も可）にて必ずご提出ください。"]
[null,"※「保障の見直し」に関する書類のみを鮮明に撮影してください。"]
[]
[null,"個人情報につき取扱い注意　※FAX使用不可"]
[null,"＜組合記入欄＞"]
[null,"組合名",null,null,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貴労組や会社で加入できる共済(保険)"]
[null,"支部名",null,null,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こくみん共済coopの団体生命共済の取り組み"]
[null,"共済担当者名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※①②が「有」の場合、保障額と保険料（掛金）が分かる\n　該当資料をコンポーズサービスにご提供ください。"]
[null,"組合TEL"]
[null,"担当者E-mail",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※東京地協・千葉地協加盟組合以外はマックスへ"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電機連合福祉共済センター・総合代理店\nコンポーズサービス"]
[null,"＜コンポーズサービス記入欄＞"]
[null,"対応者",null,null,null,"連携方法・日時",null,null,null,null,null,"組合連絡日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付印",null,null,null,"  〒170-0005"]
[null,null,null,null,null,null,null,null,null,null,null,"受付日",null,null,null,null,null,"完了日",null,null,null,null,null,"発送日",null,null,null,null,null,null,null,null,null,"   東京都豊島区南大塚1-13-4"]
[null,null,null,null,null,null,null,"月",null,null,"日",null,null,"月",null,null,"日",null,null,"月",null,null,"日",null,null,"月",null,null,"日",null,null,null,null,"  TEL：03-3942-9535"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail：cps@compose365.onmicrosoft.com"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(2021.09)"]

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[null,"保険・共済等「保障見直し診断申込書」"]
[]
[]
[null,"※【「保障見直し診断」のご案内】を確認の上ご記入ください。"]
[null,"※　　　の部分は該当するものを〇で囲んでください。"]
[null,"※所属組合ごとの申込者情報をコンポーズサービスと所属組合で共有させていただきます。"]
[null,"※本申込みにより取得した個人情報は、電機連合福祉共済センター総合代理店コンポーズサービスへの連絡や診断結果の受領など、本診断に関連"]
[null,"  することにのみ利用します。"]
[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,null,null,"申込日",null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"●ご相談者様",null,null,null,null,null,"フリガナ"]
[null,null,null,null,null,null,null,"お名前"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ご年齢",null,null,null,null,"歳",null,"性別",null,"男・女"]
[]
[null,null,null,null,null,null,null,"生年月日（西暦）",null,null,null,null,null,null,null,"年",null,"月",null,"日",null,"日中の連絡先",null,null,null,null,"会社・自宅・携帯",null,null,null,null,null,null,null,null,"電話番号"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"＠"]
[]
[null,"●ご住所",null,null,null,null,null,null,null,null,null,null,"都・道・府・県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市・区・町・村・郡"]
[]
[null,null,null,null,null,null,"持ち家",null,null,"有・無",null,null,null,"→",null,"有の場合、団体信用生命保険へのご加入は",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有・無"]
[]
[null,"●配偶者",null,null,null,null,"配偶者",null,null,"有・無",null,null,null,null,null,"ご年齢",null,null,null,null,"歳",null,null,"生年月日（西暦）",null,null,null,null,null,null,null,"年",null,"月",null,"日"]
[]
[null,null,null,null,null,null,"電機連合の組合員ですか？",null,null,null,null,null,null,null,null,"はい・いいえ",null,null,null,null,null,null,null,"就労状況",null,null,null,"有・無",null,null,null,null,null,"雇用形態",null,null,null,"会社員 ・ パート\nアルバイト ・ その他"]
[]
[null,null,null,null,null,null,"収入割合",null,null,null,"ご本人：配偶者＝",null,null,null,null,null,null,null,null,"：",null,null,"※0～10の数字をご記入ください。"]
[]
[null,"●お子様",null,null,null,null,"有・無",null,null," → 有の場合、お子様の年齢・生年月日（西暦）をご記入ください。"]
[null,null,null,null,null,null,null,null,null,null,"第1子",null,null,null,null,null,"歳",null,null,"第2子",null,null,null,null,null,"歳",null,null,"第3子",null,null,null,null,null,"歳",null,null,"第4子",null,null,null,null,null,"歳"]
[null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日生",null,null,null,null,"年",null,"月",null,"日生",null,null,null,null,"年",null,"月",null,"日生",null,null,null,null,"年",null,"月",null,"日生"]
[]
[null,"●その他扶養者",null,null,null,null,null,null,"有・無",null,null,null,null,"扶養者構成",null,null,null,null," 父 ・ 母 ・ 兄 ・ 弟 ・ 姉 ・ 妹 ・ その他（　　　　　　　　）"]
[]
[null,"●回答方法について",null,null,null,null,null,null,null,null,"ご希望の回答方法",null,null,null,null,null,null,"郵送 ・ メール ・ 面談(対面) ・ 面談(WEB)"]
[]
[null,"現在加入の保険・共済"]
[null,"団体生命保険・団体医療保険・生命保険・医療保険・傷害保険・グループ保険・個人年金保険など"]
[null,"ご加入者",null,null,null,"加入日\n(西暦)",null,null,null,null,null,null,"見直しする保険･共済の会社名と商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険料(掛金)\n月額"]
[]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,null,null,null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"年",null,"月",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,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,"保険料(掛金)総額",null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,"保障見直し診断に際してのご要望点 （〇印をつけてください。複数可）"]
[null,"1.掛け金を安く　2.医療保障を重点に　3.生命保障を重点に　4.老後保障を重点に"]
[null,"その他ご要望等ございましたらご記入ください。\n"]
[]
[]
[]
[null,"正確な診断をするために、見直しする保険･共済の詳細内容がわかる"]
[null,"「保険証券(共済証書)」「ご契約内容のお知らせ等」更新時の「提案書」などのコピーを一式"]
[null,"メールまたは郵送（PDF・スマートフォンで撮影した写真データ※も可）にて必ずご提出ください。"]
[null,"※「保障の見直し」に関する書類のみを鮮明に撮影してください。"]
[]
[null,"個人情報につき取扱い注意　※FAX使用不可"]
[null,"＜組合記入欄＞"]
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[null,"共済担当者名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※①②が「有」の場合、保障額と保険料（掛金）が分かる\n　該当資料をコンポーズサービスにご提供ください。"]
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[null,"担当者E-mail",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※東京地協・千葉地協加盟組合以外はマックスへ"]
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[null,"＜コンポーズサービス記入欄＞"]
[null,"対応者",null,null,null,"連携方法・日時",null,null,null,null,null,"組合連絡日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付印",null,null,null,"  〒170-0005"]
[null,null,null,null,null,"メール・電話・郵送",null,null,null,null,null,"受付日",null,null,null,null,null,"完了日",null,null,null,null,null,"発送日",null,null,null,null,null,null,null,null,null,"   東京都豊島区南大塚1-13-4"]
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