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["6月末日締切",{"$nulls":18},"教弘保険\nご加入の方"]
[]
["　　　　　　　　小学校・高等学校入学祝金申請書"]
[]
["公益財団法人日本教育公務員弘済会徳島支部長　様"]
[]
[null,"次のとおり申請します。"]
[]
[{"$nulls":4},"申請日　  　　　年　　　月　　　日"]
[{"$nulls":8},"氏　名(自署)"]
[{"$nulls":8},"勤務校(園)\n関係機関"]
[{"$nulls":8},"*現在勤務されていない場合は、最終勤務校(園)とその年度をご記入ください。"]
[]
[null,null,"校　種　                 (いずれかに○を入れてください）",{"$nulls":5}," 小学校　　　　・　　　　高等学校"]
[null,null,"入学生氏名"]
[]
[null,"○　入学祝金は銀行振込とさせていただきますので、口座番号等をご記入ください。"]
[null,"*お振込口座は原則として、阿波銀行の本・支店口座でお願いいたします。"]
[]
[null,"振込先口座"]
[]
[null,null,"氏　名",{"$nulls":7},"口座名義人（カナ）"]
[]
[null,null,"銀行名",{"$nulls":4},"本・支店名",{"$nulls":5},"口座番号"]
[null,null,"銀行",{"$nulls":4},"支店",{"$nulls":5},"普通"]
[]
[null,"○　この用紙を、次のいずれかの方法で徳島支部にお送りください。"]
[null,null,"・郵送",null,"〒７７０－０９０４"]
[{"$nulls":4},"徳島市新町橋２丁目１４番地１　マーキュリービル７階"]
[{"$nulls":4},"公益財団法人日本教育公務員弘済会徳島支部　行"]
[{"$nulls":4},"電話（０８８）６５２－０３３３"]
[]
[null,null,"・ジブラルタ生命保険株式会社の学校担当ＬＣへ手渡し。"]
[]
[null,null,null,"＊個人情報につきましては、個人情報保護法に基づき厳重にお取り扱いさせていただきます。\n詳しくは、日教弘ホームページ(http://www.nikkyoko.or.jp）をご覧ください。"]
["　"]
["徳島支部使用欄"]
[{"$nulls":8},"営業所",null,null,"担当ＬＣ",null,null,"備　 考"]