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["（FK-42）"]
[]
["ポイントカード変更届"]
[]
["　以下の内容を届出ます。"]
[]
["届出欄（太枠内を記入ください。）"]
["届出日",null,"令和",null,null,null,"年",null,null,null,"月",null,null,null,"日"]
["カードID",null,0,0,0,null,"-",0,1,"-",0,0,0,0]
["記入者"]
["ﾎﾟｲﾝﾄｶｰﾄﾞ発行申請時の事務所名"]
["届出内容",null,"□","申請内容の変更　→　変更内容を記載ください。"]
[null,null,"□","返却・紛失等　→　カードがお手元にある場合はあわせて返却ください。"]
[]
["変更内容（太枠内のうち変更となった内容のみを記入ください。）"]
["フリガナ"]
["事務所名"]
["事務所の所在地",null,"〒",{"$nulls":5},"－"]
[]
["電話番号"]
[]
[]
["事務処理欄"]
["担当部署",null,"□　構造判定部　（コード　５　）"]
[]
["受領日",null,"令和",null,null,null,"年",null,null,null,"月",null,null,null,"日"]
["管理簿入力日",null,"令和",null,null,null,"年",null,null,null,"月",null,null,null,"日"]
["確認欄",null,"発行者",null,null,null,"管理簿入力者",{"$nulls":7},"部長"]

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[{"$nulls":17},"様式3-3"]
[]
["ポイントカード変更届(記入例)"]
[]
["　以下の内容を届出ます。"]
[]
["届出欄（太枠内を記入ください。）"]
["届出日",null,"令和",null,"元",null,"年",null,5,null,"月",null,7,null,"日"]
["カードID",null,0,0,0,1,"-",0,1,"-",0,0,0,0,0,0,0,1]
["記入者",null,"○○　○○"]
["ﾎﾟｲﾝﾄｶｰﾄﾞ発行申請時の事務所名",null,"○○設計事務所"]
["届出内容",null,"■","申請内容の変更　→　変更内容を記載ください。"]
[null,null,"□","返却・紛失等　→　カードがお手元にある場合はあわせて返却ください。"]
[]
["変更内容（太枠内のうち変更となった内容のみを記入ください。）"]
["フリガナ",null,"△△セッケイジムショ"]
["事務所名",null,"△△設計事務所"]
["事務所の所在地",null,"〒",{"$nulls":5},"－"]
[]
["電話番号"]
[]
[]
["事務処理欄"]
["担当部署",null,"□　構造判定部　（コード　５　）"]
[]
["受領日",null,"令和",null,null,null,"年",null,null,null,"月",null,null,null,"日"]
["管理簿入力日",null,"令和",null,null,null,"年",null,null,null,"月",null,null,null,"日"]
["確認欄",null,"発行者",null,null,null,"管理簿入力者",{"$nulls":7},"部長"]