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["別紙第57"]
[{"$nulls":5},"奨 学 援 護 金",{"$nulls":6},"の支給に係る現状報告書"]
[{"$nulls":5},"就労保育援護金"]
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["（実施機関の長の官職氏名）",{"$nulls":21},"令和",null,null,null,"年",null,null,"月",null,null,"日"]
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[{"$nulls":13},"殿"]
["下記のとおり",null,null,null,"奨 学 援 護 金",{"$nulls":4},"の支給に係る現状を報告します。"]
[{"$nulls":4},"就労保育援護金"]
[{"$nulls":13},"報告者の住所"]
[{"$nulls":13},"氏名"]
[{"$nulls":13},"被災職員との続柄"]
["１　報告者の受けている補償の種類　　　　　　　　　",{"$nulls":20},"２　年金証書の番号"]
[null,"□","傷病補償年金　　　　　　　　　　　　　　　　　　　　"]
[null,"□","障害補償年金",null,null,null,"（障害等級",null,null,null,"第",null,null,"級）",{"$nulls":11},"第",{"$nulls":7},"号"]
[null,"□","遺族補償年金　　　　　　　　　　　　　　　　　　　　"]
["３　在学者等",null,null,null,"に関する事項",{"$nulls":4},"＊欄は、奨学援護金に係る在学者等について",{"$nulls":13},"記入すること。"]
["　　保 育 児",{"$nulls":8},"※欄は、就労保育援護金に係る保育児について"]
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["学校等、保育所等の所在地"]
["＊\n奨学援護\n金に係る\n在学者等",null,null,"入 学 等 年 月",{"$nulls":6},"年",{"$nulls":4},"月",null,null,null,"年",{"$nulls":4},"月",null,null,null,"年",{"$nulls":4},"月"]
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["支給事由消滅年月",{"$nulls":7},"令和\n",null,null,"年",null,null,"月",null,null,"令和\n",null,null,"年",null,null,"月",null,null,"令和\n",null,null,"年",null,null,"月"]
["支給事由が消滅した理由",{"$nulls":8},"□","卒業、卒園等",{"$nulls":7},"□","卒業、卒園等",{"$nulls":7},"□","卒業、卒園等"]
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[{"$nulls":9},"□","その他　内容",{"$nulls":7},"□","その他　内容",{"$nulls":7},"□","その他　内容"]
[]
["４　就労している者に関する事項（就労保育援護金の支給に係る報告の場合に記入すること。）"]
["就労している者の氏名",{"$nulls":19},"生　年　月　日",{"$nulls":8},"年",null,"月",null,"日生"]
["就労している者の住所",{"$nulls":19},"報告者との続柄"]
["勤務している会社等の\n名称・所在地"]
["５　特　記　事　項"]
["６　添付する書類"]
["　注１　該当する□にレ印を記入すること。\n　　２　「５　特記事項」の欄には、在学者等、保育児又は就労している者に関し、最近１年間において、停学、休\n　　　学、留年、転職等特記すべき事項がある場合に記入すること。"]