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["様式４"]
[]
[]
[{"$nulls":8},"令和３年（２０２１年）　　月　　日"]
[]
["閲覧資料貸出申込書兼誓約書"]
[]
[]
["（あて先）西知多医療厚生組合　管理者"]
[]
[]
[{"$nulls":4},"所在地"]
[{"$nulls":4},"商号又は名称"]
[{"$nulls":4},"代表者氏名",null,null,null,"印"]
[]
["　令和３年（２０２１年）３月１日付で公表された「健康増進施設整備・運営事業」実施方針等に係る閲覧資料の貸出を、下記のとおり申し込みます。貸出された閲覧資料を、「健康増進施設整備・運営事業」に係るもの以外の目的で使用しないことを誓約します。また、返却予定日までに、貸出された閲覧資料を返却します。"]
[]
[]
[]
[]
[]
["記"]
[]
["１．貸出希望日",null,"令和３年（２０２１年）　　　 月　　　 日"]
["２．返却予定日",null,"令和３年（２０２１年）　　　 月　　　 日"]
["３．返却方法",null,"（　窓口にて返却　　／　　郵送にて返却　　　）"]
["４．連絡先"]
["会社名"]
["部　署"]
["担当者氏名"]
["電話番号"]
[]
[]
["※事務局使用欄"]
[null,"受付日",null,null,null,"返却日"]
[]
[null,"　貸出CD番号（　　　　）"]