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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,1934,"(昭和9)","1934(昭和9)",5,5]
[null,null,null,null,"受付印",null,null,null,null,null,null,null,null,null,null,null,null,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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1935,"(昭和10)","1935(昭和10)",6,6]
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[null,"越谷市長　宛",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1941,"(昭和16)","1941(昭和16)",12,12]
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[null,null,null,"私は、越谷市に請求する支払金額について下記の指定口座への振込みを依頼します。\nなお、登録より５年間、使用履歴、変更登録がない場合は、債権者登録が削除されることに同意いたします。",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,1943,"(昭和18)","1943(昭和18)",null,14]
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[null,"※２枚目裏面の「記入上の注意」をお読みの上、太線枠内のみ記入してください。",null,null,null,null,null,null,null,null,null,null,null,null,"申請区分",null,null,null,null,null,null,null,null,"変更等の内容",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"債権者登録番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1947,"(昭和22)","1947(昭和22)",null,18]
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[null,null,null,"個人",null,null,"氏    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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1955,"(昭和30)","1955(昭和30)",null,26]
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[null,null,null,null,null,null,"生年月日",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,null,null,null,null,null,null,null,null,null,1959,"(昭和34)","1959(昭和34)",null,30]
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[null,null,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,"代表者印",null,null,null,null,null,null,null,null,null,null,"法人印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962,"(昭和37)","1962(昭和37)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和38)","1963(昭和38)"]
[null,null,null,"法人(事業者)",null,null,"名    称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和39)","1964(昭和39)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和40)","1965(昭和40)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和41)","1966(昭和41)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和42)","1967(昭和42)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和43)","1968(昭和43)"]
[null,null,null,null,null,null,null,null,null,null,null,"※支店名・営業所等まで記入してください。",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,1969,"(昭和44)","1969(昭和44)"]
[null,null,null,null,null,null,"代 表 者",null,null,null,null,"役職名",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970,"(昭和45)","1970(昭和45)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和46)","1971(昭和46)"]
[null,null,null,null,null,null,null,null,null,null,null,"氏    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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,"(昭和47)","1972(昭和47)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和48)","1973(昭和48)"]
["電話番号",null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,"-",null,null,null,null,null,null,null,"FAX",null,null,null,null,null,null,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,"(昭和49)","1974(昭和49)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和50)","1975(昭和50)"]
["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,null,null,null,null,null,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,"(昭和51)","1976(昭和51)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和52)","1977(昭和52)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和53)","1978(昭和53)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和54)","1979(昭和54)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和55)","1980(昭和55)"]
["振 込 先",null,null,null,null,"１．通常口座（債権者登録口座数は１債権者について１口座です。)",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,"２．工事等前払金口座",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1981,"(昭和56)","1981(昭和56)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和57)","1982(昭和57)"]
[null,null,null,"金　融　機　関　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関コード",null,null,null,null,null,null,null,null,null,null,null,"支　店　名",null,null,null,null,null,null,null,null,null,null,null,null,null,"支店コード",null,null,null,null,null,null,null,null,null,null,null,null,null,1983,"(昭和58)","1983(昭和58)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和59)","1984(昭和59)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"銀　　　行",null,null,null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,null,null,1985,"(昭和60)","1985(昭和60)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"信用金庫",null,null,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　　店",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1986,"(昭和61)","1986(昭和61)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"農　　　協",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和62)","1987(昭和62)"]
[null,null,null,"預金種別",null,null,null,null,null,null,null,null,"口座番号（右づめで記入）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口座名義（カタカナで記入してください。）",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,1988,"(昭和63)","1988(昭和63)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和64)","1989(昭和64)"]
[null,null,null,null,null,"普　　 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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"------","------","------------"]
[null,null,null,null,null,"当　　 座",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,"そ の 他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成元)","1989(平成元)"]
[null,null,null,"( 　　　　　　　　 )",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成2)","1990(平成2)"]
["※振込先の口座は、通帳をよく確認のうえ、記入してください。",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,1991,"(平成3)","1991(平成3)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成4)",{"$f":"BJ66&\"\"&BK66","v":"1992(平成4)"},null,null,null,null,{"$f":"MID($AC65,COLUMN()-2,1)","v":""},"","","","","","","","","","","","","","","","",""]
["※申請書に関するお問合せ先をご記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※越谷市記入欄",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,1993,"(平成5)","1993(平成5)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成6)","1994(平成6)"]
["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,"担当課",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入力者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1995,"(平成7)","1995(平成7)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成8)","1996(平成8)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者",null,null,null,"（内：　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,"備　考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1997,"(平成9)","1997(平成9)"]
["連絡先電話番号",null,null,null,null,null,null,null,null,null,null,null,"－",null,null,null,null,null,"－",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成10)","1998(平成10)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返　却",null,null,null,"□郵送　　　　□担当課",null,null,null,null,null,null,null,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,"(平成11)","1999(平成11)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成12)","2000(平成12)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成13)","2001(平成13)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"債権者登録申請書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"控",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2002,"(平成14)","2002(平成14)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成15)","2003(平成15)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2004,"(平成16)","2004(平成16)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成17)","2005(平成17)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2006,"(平成18)","2006(平成18)"]
[null,null,null,null,"受付印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AP6=\"\",\"\",AP6)","v":"　　年　　月　　日"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2007,"(平成19)","2007(平成19)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2008,"(平成20)","2008(平成20)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成21)","2009(平成21)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成22)","2010(平成22)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2011,"(平成23)","2011(平成23)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成24)","2012(平成24)"]
[null,"越谷市長　宛",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"MID($AC65,COLUMN()-2,1)","v":""},null,null,null,null,null,null,null,null,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,"(平成25)","2013(平成25)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成26)","2014(平成26)"]
[null,null,null,"私は、越谷市に請求する支払金額について下記の指定口座への振込みを依頼します。\nなお、登録より５年間、使用履歴がない場合は、債権者登録が削除されることに同意いたします。\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成27)","2015(平成27)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成28)","2016(平成28)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成29)","2017(平成29)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"債権者登録番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2018,"(平成30)","2018(平成30)"]
[null,"※２枚目裏面の「記入上の注意」をお読みの上、太線枠内のみ記入してください。",null,null,null,null,null,null,null,null,null,null,null,null,"申請区分",null,null,null,null,null,null,null,null,"変更等の内容",null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成31)","2019(平成31)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,null,null,null,null,null,null,null,false,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,false,null,null,false,null,null,false,null,null,false,null,null,false,null,null,false,null,null,false,null,null,null,null,"その他","（　　　）",null,null,null,null,{"$f":"IF(AS20=\"\",\"\",AS20)","v":""},null,{"$f":"IF(AU20=\"\",\"\",AU20)","v":""},null,{"$f":"IF(AW20=\"\",\"\",AW20)","v":""},null,{"$f":"IF(AY20=\"\",\"\",AY20)","v":""},null,{"$f":"IF(BA20=\"\",\"\",BA20)","v":""},null,{"$f":"IF(BC20=\"\",\"\",BC20)","v":""},null,null,null,null,null,null,2019,"(令和元)","2019(令和元)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新　規",false,null,"変 更",false,null,"廃　止",null,null,"法人名",null,null,"代表者",null,null,"口　座",false,null,"住　所",null,null,"印　鑑",null,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,"(令和2)","2020(令和2)"]
["申請者(債権者)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,true,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,2021,"(令和3)","2021(令和3)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2022,"(令和4)","2022(令和4)"]
["債権者",null,null,false,null,null,"フリガナ",null,null,null,null,{"$f":"IF(L24=\"\",\"\",L24)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人認印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2023,"(令和5)","2023(令和5)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2024,"(令和6)","2024(令和6)"]
[null,null,null,"個人",null,null,"氏    名",null,null,null,null,{"$f":"IF(L26=\"\",\"\",L26)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2025,"(令和7)","2025(令和7)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2026,"(令和8)","2026(令和8)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2027,"(令和9)","2027(令和9)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2028,"(令和10)","2028(令和10)"]
[null,null,null,null,null,null,"生年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(M31=\"\",\"\",M31)","v":""},null,null,null,null,null,null,null,"年",null,{"$f":"IF(W31=\"\",\"\",W31)","v":""},null,null,null,"月",null,{"$f":"IF(AC31=\"\",\"\",AC31)","v":""},null,null,null,"日"]
[]
[null,null,null,false,null,null,"フリガナ",null,null,null,null,{"$f":"IF(L33=\"\",\"\",L33)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"代表者印",null,null,null,null,null,null,null,null,null,null,"法人印"]
[]
[null,null,null,"法人(事業者)",null,null,"名    称",null,null,null,null,{"$f":"IF(L35=\"\",\"\",L35)","v":""}]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"※支店名・営業所等まで記入してください。"]
[null,null,null,null,null,null,"代 表 者",null,null,null,null,"役職名",null,null,null,null,null,null,{"$f":"IF(S41=\"\",\"\",S41)","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,"氏    名",null,null,null,null,null,null,{"$f":"IF(S43=\"\",\"\",S43)","v":""}]
[]
["電話番号",null,null,null,null,null,{"$f":"IF(G45=\"\",\"\",G45)","v":""},null,null,null,null,null,"-",null,{"$f":"IF(O45=\"\",\"\",O45)","v":""},null,null,null,null,null,"-",null,{"$f":"IF(W45=\"\",\"\",W45)","v":""},null,null,null,null,null,"FAX",null,null,null,null,null,{"$f":"IF(AI45=\"\",\"\",AI45)","v":""},null,null,null,null,null,"-",null,{"$f":"IF(AQ45=\"\",\"\",AQ45)","v":""},null,null,null,null,null,"-",null,{"$f":"IF(AY45=\"\",\"\",AY45)","v":""}]
[]
["住所",null,null,"〒",null,null,{"$f":"IF(G47=\"\",\"\",G47)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(U47=\"\",\"\",U47)","v":""}]
[]
[null,null,null,{"$f":"IF(D49=\"\",\"\",D49)","v":""}]
[]
[]
["振 込 先",null,null,false,null,"１．通常口座（債権者登録口座数は１債権者について１口座です。)",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,false,null,"２．工事等前払金口座"]
[]
[null,null,null,"金　融　機　関　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関コード",null,null,null,null,null,null,null,null,null,null,null,"支　店　名",null,null,null,null,null,null,null,null,null,null,null,null,null,"支店コード"]
[]
[null,null,null,{"$f":"IF(D56=\"\",\"\",D56)","v":""},null,null,null,null,null,null,null,null,null,null,false,null,"銀　　　行",null,null,null,null,{"$f":"IF(V56=\"\",\"\",V56)","v":""},null,null,{"$f":"IF(Y56=\"\",\"\",Y56)","v":""},null,null,{"$f":"IF(AB56=\"\",\"\",AB56)","v":""},null,null,{"$f":"IF(AE56=\"\",\"\",AE56)","v":""},null,null,{"$f":"IF(AH56=\"\",\"\",AH56)","v":""},null,null,null,null,null,null,null,false,null,"本　　店",null,null,null,{"$f":"IF(AV56=\"\",\"\",AV56)","v":""},null,null,{"$f":"IF(AY56=\"\",\"\",AY56)","v":""},null,null,{"$f":"IF(BB56=\"\",\"\",BB56)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,null,"信用金庫",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,null,"支　　店"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,null,"農　　　協",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,"預金種別",null,null,null,null,null,null,null,null,"口座番号（右づめで記入）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口座名義（カタカナで記入してください。）"]
[]
[null,null,null,false,null,"普　　 通",null,null,null,null,null,null,{"$f":"IF(M61=\"\",\"\",M61)","v":""},null,{"$f":"IF(O61=\"\",\"\",O61)","v":""},null,{"$f":"IF(Q61=\"\",\"\",Q61)","v":""},null,{"$f":"IF(S61=\"\",\"\",S61)","v":""},null,{"$f":"IF(U61=\"\",\"\",U61)","v":""},null,{"$f":"IF(W61=\"\",\"\",W61)","v":""},null,{"$f":"IF(Y61=\"\",\"\",Y61)","v":""},null,{"$f":"IF(AA61=\"\",\"\",AA61)","v":""},null,{"$f":"IF(AC61=\"\",\"\",AC61)","v":""},null,{"$f":"IF(AE61=\"\",\"\",AE61)","v":""},null,{"$f":"IF(AG61=\"\",\"\",AG61)","v":""},null,{"$f":"IF(AI61=\"\",\"\",AI61)","v":""},null,{"$f":"IF(AK61=\"\",\"\",AK61)","v":""},null,{"$f":"IF(AM61=\"\",\"\",AM61)","v":""},null,{"$f":"IF(AO61=\"\",\"\",AO61)","v":""},null,{"$f":"IF(AQ61=\"\",\"\",AQ61)","v":""},null,{"$f":"IF(AS61=\"\",\"\",AS61)","v":""},null,{"$f":"IF(AU61=\"\",\"\",AU61)","v":""},null,{"$f":"IF(AW61=\"\",\"\",AW61)","v":""},null,{"$f":"IF(AY61=\"\",\"\",AY61)","v":""},null,{"$f":"IF(BA61=\"\",\"\",BA61)","v":""},null,{"$f":"IF(BC61=\"\",\"\",BC61)","v":""}]
[null,null,null,false,null,"当　　 座"]
[null,null,null,false,null,"そ の 他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AA63=\"\",\"\",AA63)","v":""},null,{"$f":"IF(AC63=\"\",\"\",AC63)","v":""},null,{"$f":"IF(AE63=\"\",\"\",AE63)","v":""},null,{"$f":"IF(AG63=\"\",\"\",AG63)","v":""},null,{"$f":"IF(AI63=\"\",\"\",AI63)","v":""},null,{"$f":"IF(AK63=\"\",\"\",AK63)","v":""},null,{"$f":"IF(AM63=\"\",\"\",AM63)","v":""},null,{"$f":"IF(AO63=\"\",\"\",AO63)","v":""},null,{"$f":"IF(AQ63=\"\",\"\",AQ63)","v":""},null,{"$f":"IF(AS63=\"\",\"\",AS63)","v":""},null,{"$f":"IF(AU63=\"\",\"\",AU63)","v":""},null,{"$f":"IF(AW63=\"\",\"\",AW63)","v":""},null,{"$f":"IF(AY63=\"\",\"\",AY63)","v":""},null,{"$f":"IF(BA63=\"\",\"\",BA63)","v":""},null,{"$f":"IF(BC63=\"\",\"\",BC63)","v":""}]
[null,null,null,{"$f":"IF(D64=\"\",\"\",D64)","v":"( 　　　　　　　　 )"}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お問い合わせ先"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〒３４３―８５０１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"埼玉県越谷市越ヶ谷四丁目２番１号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"越谷市役所会計課"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(０４８－９６３－９２５２（直通）"]

{"sheet":"記入上の注意","index":1,"n_rows":73,"n_cols":4,"rows_kept":73,"cut":false,"hidden":false,"merged":[[62,0,63,1],[62,3,63,52],[64,3,65,52],[50,3,51,52],[52,3,53,52],[54,3,55,52],[56,3,57,52],[58,3,59,52],[70,3,71,52],[68,3,69,52],[72,3,73,52],[0,0,3,54],[37,0,38,1],[18,0,19,1],[33,0,34,1],[18,3,19,52],[23,3,24,52],[25,3,26,52],[27,3,28,52],[33,3,34,52],[37,3,38,52],[39,3,40,52],[44,3,45,52],[46,3,47,52],[48,3,49,52],[5,0,6,1],[14,0,15,1],[5,3,6,52],[10,3,11,52],[7,3,8,52],[14,3,15,52]]}
["記入上のご注意"]
[]
[]
[]
[]
[1,null,null,"この申請書には、契約書の契約者・請求書の請求者欄と同一の内容を記入し、"]
[]
[null,null,null,"同じ印鑑を使用してください。"]
[]
[]
[null,null,null,"訂正箇所には、代表者印又は個人印の押印が必要です。"]
[]
[]
[]
[2,null,null,"債権者登録口座数は、１債権者について１口座です。"]
[]
[]
[]
[3,null,null,"振込エラーを防止するため振込先の口座は、通帳をよく確認のうえ記入してください。"]
[]
[]
[]
[]
[null,null,null,"※預金通帳のカナ名義等が印字されている部分、ゆうちょ銀行の場合は、"]
[]
[null,null,null,"　「他の金融機関からの振込の受取口座」の店名・預金種別・口座番号（７桁）"]
[]
[null,null,null,"　 が印字されている銀行使用欄のページを確認のうえ記入してください。"]
[]
[]
[]
[]
[]
[4,null,null,"変更届の場合でも、内容（押印含む）は全部記入してください。"]
[]
[]
[]
[5,null,null,"本申請書に関してお問い合わせをする場合がありますので、債権者の方は"]
[]
[null,null,null,"「担当者名」及び「連絡先電話番号」を記入してください。"]
[]
[]
[]
[]
[null,null,null,"　後日、申請書の控えが申請者へ郵送されますので、大切に保管してください。"]
[]
[null,null,null,"一度登録された申請内容は越谷市で保管し、継続して使用しますが、登録より５年間、"]
[]
[null,null,null,"使用履歴、変更登録がない場合は、廃止の申請がされていなくても登録を削除する"]
[]
[null,null,null,"ことがあります。"]
[]
[null,null,null,"　また、請求書作成の際は、「債権者登録番号」を所定欄に記入していただければ、"]
[]
[null,null,null,"振込先の記入は不要です。"]
[]
[null,null,null,"　なお、振込みのお知らせはいたしませんので、通帳で課名、金額をご確認ください。"]
[]
[]
[]
[]
[]
[6,null,null,"本申請書に添付していただいた書類は、会計課受理から１年経過した後、"]
[]
[null,null,null,"破棄させていただきます。"]
[]
[]
[]
[null,null,null,"※越谷市に業者登録をされている方で、振込先及び使用印以外を変更する場合は、"]
[]
[null,null,null,"　 契約課の所定様式にて変更が必要です。"]
[]
[null,null,null,"※支社・支店・営業所等で登録を希望の方は、別途所定の委任状の提出が必要です。"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"債権者登録申請書",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,1930,"(昭和5)",{"$f":"BJ1&\"\"&BK1","v":"1930(昭和5)"},1,1]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1931,"(昭和6)",{"$f":"BJ2&\"\"&BK2","v":"1931(昭和6)"},2,2]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1932,"(昭和7)","1932(昭和7)",3,3]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1933,"(昭和8)","1933(昭和8)",4,4]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1934,"(昭和9)","1934(昭和9)",5,5]
[null,null,null,null,"受付印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和　〇年　〇月　〇日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1935,"(昭和10)","1935(昭和10)",6,6]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1936,"(昭和11)","1936(昭和11)",7,7]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1937,"(昭和12)","1937(昭和12)",8,8]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1938,"(昭和13)","1938(昭和13)",9,9]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1939,"(昭和14)","1939(昭和14)",10,10]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1940,"(昭和15)","1940(昭和15)",11,11]
[null,"越谷市長　宛",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1941,"(昭和16)","1941(昭和16)",12,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1942,"(昭和17)","1942(昭和17)",null,13]
[null,null,null,"私は、越谷市に請求する支払金額について下記の指定口座への振込みを依頼します。\nなお、登録より５年間、使用履歴、変更登録がない場合は、債権者登録が削除されることに同意いたします。",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,1943,"(昭和18)","1943(昭和18)",null,14]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1944,"(昭和19)","1944(昭和19)",null,15]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1945,"(昭和20)","1945(昭和20)",null,16]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1946,"(昭和21)","1946(昭和21)",null,17]
[null,"※２枚目裏面の「記入上の注意」をお読みの上、太線枠内のみ記入してください。",null,null,null,null,null,null,null,null,null,null,null,null,"申請区分",null,null,null,null,null,null,null,null,"変更等の内容",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"債権者登録番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1947,"(昭和22)","1947(昭和22)",null,18]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1948,"(昭和23)","1948(昭和23)",null,19]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他","（　　　）",null,null,null,null,0,null,1,null,2,null,3,null,4,null,5,null,null,null,null,null,null,1949,"(昭和24)","1949(昭和24)",null,20]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新　規",null,null,"変 更",null,null,"廃　止",null,null,"法人名",null,null,"代表者",null,null,"口　座",null,null,"住　所",null,null,"印　鑑",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1950,"(昭和25)","1950(昭和25)",null,21]
["申請者(債権者)",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,1951,"(昭和26)","1951(昭和26)",null,22]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1952,"(昭和27)","1952(昭和27)",null,23]
["債権者",null,null,null,null,null,"フリガナ",null,null,null,null,"〇〇　〇〇",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人認印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1953,"(昭和28)","1953(昭和28)",null,24]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1954,"(昭和29)","1954(昭和29)",null,25]
[null,null,null,"個人",null,null,"氏    名",null,null,null,null,"〇〇　〇〇",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1955,"(昭和30)","1955(昭和30)",null,26]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1956,"(昭和31)","1956(昭和31)",null,27]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1957,"(昭和32)","1957(昭和32)",null,28]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1958,"(昭和33)","1958(昭和33)",null,29]
[null,null,null,null,null,null,"生年月日",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,null,null,null,null,null,null,null,null,null,1959,"(昭和34)","1959(昭和34)",null,30]
[null,null,null,null,null,null,null,null,null,null,null,null,"1975(昭和50)",null,null,null,null,null,null,null,"年",null,10,null,null,null,"月",null,10,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,null,1960,"(昭和35)","1960(昭和35)",null,31]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和36)","1961(昭和36)"]
[null,null,null,null,null,null,"フリガナ",null,null,null,null,"カブシキガイシャ　△△インサツ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"代表者印",null,null,null,null,null,null,null,null,null,null,"法人印",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962,"(昭和37)","1962(昭和37)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和38)","1963(昭和38)"]
[null,null,null,"法人(事業者)",null,null,"名    称",null,null,null,null,"株式会社　△△印刷",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和39)","1964(昭和39)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和40)","1965(昭和40)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和41)","1966(昭和41)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和42)","1967(昭和42)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和43)","1968(昭和43)"]
[null,null,null,null,null,null,null,null,null,null,null,"※支店名・営業所等まで記入してください。",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,1969,"(昭和44)","1969(昭和44)"]
[null,null,null,null,null,null,"代 表 者",null,null,null,null,"役職名",null,null,null,null,null,null,"代表取締役",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和45)","1970(昭和45)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和46)","1971(昭和46)"]
[null,null,null,null,null,null,null,null,null,null,null,"氏    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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,"(昭和47)","1972(昭和47)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和48)","1973(昭和48)"]
["電話番号",null,null,null,null,null,"048",null,null,null,null,null,"-",null,"◇◇◇",null,null,null,null,null,"-",null,"◇◇◇◇",null,null,null,null,null,"FAX",null,null,null,null,null,"048",null,null,null,null,null,"-",null,"◇◇◇",null,null,null,null,null,"-",null,"◇◇◇◇",null,null,null,null,null,null,null,null,null,null,1974,"(昭和49)","1974(昭和49)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和50)","1975(昭和50)"]
["住所",null,null,"〒",null,null,"343－◆◆◆◆",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和51)","1976(昭和51)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和52)","1977(昭和52)"]
[null,null,null,"埼玉県越谷市越ヶ谷４－２－１　越谷ビル４階",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和53)","1978(昭和53)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和54)","1979(昭和54)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和55)","1980(昭和55)"]
["振 込 先",null,null,null,null,"１．通常口座（債権者登録口座数は１債権者について１口座です。)",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,"２．工事等前払金口座",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1981,"(昭和56)","1981(昭和56)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和57)","1982(昭和57)"]
[null,null,null,"金　融　機　関　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関コード",null,null,null,null,null,null,null,null,null,null,null,"支　店　名",null,null,null,null,null,null,null,null,null,null,null,null,null,"支店コード",null,null,null,null,null,null,null,null,null,null,null,null,null,1983,"(昭和58)","1983(昭和58)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和59)","1984(昭和59)"]
[null,null,null,"●●●",null,null,null,null,null,null,null,null,null,null,null,null,"銀　　　行",null,null,null,null,"▲",null,null,"▲",null,null,"▲",null,null,"▲",null,null,"越谷",null,null,null,null,null,null,null,null,null,"本　　店",null,null,null,"■",null,null,"■",null,null,"■",null,null,null,null,null,null,null,1985,"(昭和60)","1985(昭和60)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"信用金庫",null,null,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　　店",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1986,"(昭和61)","1986(昭和61)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"農　　　協",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和62)","1987(昭和62)"]
[null,null,null,"預金種別",null,null,null,null,null,null,null,null,"口座番号（右づめで記入）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口座名義（カタカナで記入してください。）",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,1988,"(昭和63)","1988(昭和63)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(昭和64)","1989(昭和64)"]
[null,null,null,null,null,"普　　 通",null,null,null,null,null,null,1,null,2,null,3,null,4,null,5,null,6,null,7,null,"〇",null,"〇",null,null,null,"〇",null,"〇",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"------","------","------------"]
[null,null,null,null,null,"当　　 座",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,"そ の 他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成元)","1989(平成元)"]
[null,null,null,"( 　　　　　　　　 )",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成2)","1990(平成2)"]
["※振込先の口座は、通帳をよく確認のうえ、記入してください。",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,1991,"(平成3)","1991(平成3)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成4)",{"$f":"BJ66&\"\"&BK66","v":"1992(平成4)"},null,null,null,null,{"$f":"MID($AC65,COLUMN()-2,1)","v":""},"","","","","","","","","","","","","","","","",""]
["※申請書に関するお問合せ先をご記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※越谷市記入欄",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,1993,"(平成5)","1993(平成5)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成6)","1994(平成6)"]
["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,"担当課",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入力者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1995,"(平成7)","1995(平成7)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成8)","1996(平成8)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者",null,null,null,"（内：　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,"備　考",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1997,"(平成9)","1997(平成9)"]
["連絡先電話番号",null,null,null,null,null,null,null,null,null,null,null,"－",null,null,null,null,null,"－",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成10)","1998(平成10)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返　却",null,null,null,"□郵送　　　　□担当課",null,null,null,null,null,null,null,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,"(平成11)","1999(平成11)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成12)","2000(平成12)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,"(平成13)","2001(平成13)"]