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[null,null,"健康保険 被扶養者(異動)届",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"常務理事",null,null,null,"事務長",null,null,null,"部　長",null,null,null,"副部長･次長",null,null,null,"担当者"]
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[null,null,"事業主記入欄",null,"事業所\n所在地\n\n事業所\n名　 称\n\n事業主\n氏   名\n\n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," 　 "]
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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,"提出年月日",null,null,null,null,null,null,"：",null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
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[null,null,"事業主\n確認欄",null,"　１６歳以上の方（学生・生徒を除く）の認定申請時、事業主の確認により、対象者の「無収入に関する証明書類」を添付していない場合は、□に☑をしてください。"]
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[null,null,null,null," 　□ 対象者が所得税法上の控除対象配偶者（年末調整の際「配偶者控除」に該当予定）又は控除対象扶養親族であることを確認しました。"]
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[null,null,"「＊」のついた太枠内を除き、必要事項を入力してください。",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,"　被保険者提出日　",null,null,null,null,null,"：",null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
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[null,null,"被保険者欄",null,"被保険者\n等記号",null,null,null,null,null,null,null,null,"被保険者\n等番号",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,"標準報酬\n月  額"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
[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,"資格取得\n年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年間収入\n見込額"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"万円"]
[null,null,null,null,"住所\n（居所）",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,"備 考"]
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[null,null,"被扶養者欄 １",null,"氏名",null,null," ",null,null,null,null,null,null,null,null," ",null,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,"性別"]
[null,null,null,null,null,null,"(氏)"," ",null,null,null,null,null,null,null,"(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,"個人番号\n(認定申請時)"]
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[null,null,null,null,"住民票\n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,"続柄",null,null,null,null,null,null,"職業\n学年"]
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[null,null,null,null,"住所\n(居所)",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,"平均\n月収"]
[null,null,null,null,null,null,"  被保険者と同居",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"万円"]
[null,null,null,null,"申請\n理由",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請理\n由の日",null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,"＊\n認・削",null,null,null,"年",null,null,null,"月",null,null,null,"日"]
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[null,null,null,null,"「資格確認書」の発行要否",null,null,null,"   　 　発行が必要",null,null,null,null,null,"　※「資格確認書」の発行が必要な場合は、□にチェックをしたうえ、\n　　 「資格確認書（再）交付申請書」を併せて提出してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備考"]
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[null,null,null,null,"※被扶養者の住所（居所）が、被保険者の住所（居所）と同じ場合は、☑をしてください。その場合、住所（居所）の入力は不要です。（他の被扶養者も同様）"]
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[null,null,"被扶養者欄 ２",null,"氏名",null,null," ",null,null,null,null,null,null,null,null," ",null,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,"性別"]
[null,null,null,null,null,null,"(氏)"," ",null,null,null,null,null,null,null,"(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,"個人番号\n(認定申請時)"]
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[null,null,null,null,"住民票\n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,"続柄",null,null,null,null,null,null,"職業\n学年"]
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[null,null,null,null,"住所\n(居所)",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,"平均\n月収"]
[null,null,null,null,null,null,"  被保険者と同居",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"万円"]
[null,null,null,null,"申請\n理由",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請理\n由の日",null,null,"令和",null,null,null,null,null,null,null,null,null,null,null,null,null,"＊\n認・削",null,null,null,"年",null,null,null,"月",null,null,null,"日"]
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[null,null,null,null,"「資格確認書」の発行要否",null,null,null,"   　 　発行が必要",null,null,null,null,null,"　※「資格確認書」の発行が必要な場合は、□にチェックをしたうえ、\n　　 「資格確認書（再）交付申請書」を併せて提出してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備考"]
[]
[]
[null,null,"【注意事項】　\n　・資格確認書の発行が必要な場合（※）は、「□発行が必要」にチェックを入れてください。チェックを入れた場合、『資格確認書（再）交付申請書』を併せて提出してください。\n　　※認定申請時の職権交付の対象は、以下に該当する場合となります。\n　　　・マイナンバーカードを取得していない者、マイナンバーカードの返納者   \n　　　・マイナンバーカードを保有しているが健康保険証利用登録を行っていない者、利用登録解除を申請した者、利用登録解除者   \n　　　・マイナンバーカードの電子証明書の有効期限切れの者   \n　・認定申請をする方の住民票が日本国内に無い場合は、裏面の要件をご確認いただき、該当番号を住民票住所欄に記載したうえ、必要な書類を添付してください。\n　・被扶養者欄が足りない場合は、適宜この届書を複数枚使用してください。\n　・その他の注意事項等については、裏面をご確認ください。"]
[]
[]
[]
[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,"(裏面)Excel入力用"]
[]
[null,null,null,"〔被扶養者について〕"]
[null,null,null,"　・健康保険法に定めれれている「被扶養者」とは、「被保険者の収入によって、生計費の大部分を将来にわたり継続して維持される者」\n　  とされていますので、 自分の収入（給与、年金等すべての収入）や預貯金等で自分の生計費の半分以上を維持できる方や、生計を\n　  維持されている事実がない方は、被扶養者と認められません（その他にも一定の親族要件、同居要件、収入額の基準等もあります）。\n　・「被扶養者」は、被保険者の届け出に基づき、保険者（健康保険組合）が審査を行った上、認定又は不認定を決定しますので、届け\n　　出を行えば必ず認定されるものではありません。予めご了承願います。\n　・「被扶養者」の認定後も、定期的又は随時に扶養状況の確認（検認）を行います。\n　・健康保険における「被扶養者」は、税法上の「扶養親族」と同義ではありません。\n　・75歳以上の方等の後期高齢者医療制度の被保険者の方は申請できません。\n　・被扶養者が、被保険者資格を得た場合又は被扶養者の要件を外れた場合等は、速やかに認定削除の届け出が必要です。 "]
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[null,null,null,"〔入力の方法〕"]
[null,null,null,"  １．申請の種別、年号等は▼ の項目から選択していただき、該当する□には☑をするなどして、必要事項を入力してください。\n  ２．『続柄』は、「妻」「長男」「二女」など、被保険者との続柄を入力してください。\n  ３．『職業・学年』には、「主婦」「乳幼児」「小学生」「大学2年」「パート」「アルバイト」などと入力してください。\n  ４．『申請理由』『申請理由の日』には、「被保険者の資格取得に伴う」「出生」「婚姻」「退職」「就職」「75歳到達」「離婚」「死亡」など\n   　 「具体的な理由」及び「事実が発生した日」を入力してください。"]
[]
[]
[]
[]
[null,null,null,"〔この届書に添付して提出するもの〕"]
[null,null,null,"　【新規・追加申請時】\n　　　１．『扶養状況説明書』ならびに『確認書類』（扶養状況説明書内に明記しています）。\n　　　　　ただし、次の場合、『扶養状況説明書』の添付は不要です。\n　　　　　　Ａ.出生による「子」の申請で、「被保険者の配偶者」が既に被扶養者に認定されている場合\n          　　　（ただし、被保険者と子の姓が同じときに限ります）\n　　　　　　Ｂ.被保険者の新規取得に伴う「子」の申請で、離婚・未婚・死別により配偶者が無く、届書内の「備考欄」にその旨を入力して\n           　　 いる場合\n        　　　　（ただし、児童、就労歴の無い全日制の学生・生徒に限ります）\n　　　２．16歳以上の学生・生徒の場合は、当年度の在学が確認できる『学生証』『在学証明書』の写しが必要です。\n                （ただし、高校生以下は省略可能です）\n　　　３．日本国内に住民票が無い場合は、下記〔被扶養者の国内居住要件について〕をご確認ください。\n\n　【削除申請および訂正・氏名変更時】\n　　　◆ 申請する方の『被保険者証（カード）」、または「資格確認書」、「高齢受給者証」「限度額適用認定証」等の発行を受けている場合は、　　\n　　　　　それらの証を添付 してください。なお、紛失等により添付できないときは、『被保険者証等滅失再交付申請書』の添付が必要です。"]
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[null,null,null,"〔被扶養者の国内居住要件について〕"]
[null,null,null,"  ・被扶養者の認定要件の一つに「国内に居住していること」が原則（一定の例外有）となります。\n  ・新たに認定申請をする方の住民票が日本国内に無い場合で、以下のいずれかの要件（例外）に該当するときは、該当する番号を届\n    書内「住民票住所欄」に入力するとともに、該当する書類を添付してください。\n    なお、既に認定されている被扶養者が、国内居住要件を満たさくなったときは、その時点で削除申請の届け出が必要です。"]
[]
[]
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[null,null,null,null,null,"番号",null,"要件",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"必要となる書類"]
[null,null,null,null,null,"①",null,"　外国において留学をする学生",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　査証、学生証、在学証明書等の写し"]
[]
[null,null,null,null,null,"②",null,"　外国へ赴任する被保険者に同行する方\n　　[具体例]\n　　　・家族帯同ビザが発行される方",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　査証、海外赴任辞令、海外の公的機関が発行する居住\n　証明書等の写し"]
[]
[]
[null,null,null,null,null,"③",null,"　観光、保養又はボランティア活動、その他就労以外の目的\n　で一時的に海外へ渡航する方\n　　[具体例]\n　　　・ワーキングホリデー制度を利用して渡航する方、外国\n　　　 において留学する学生に同行する家族等、原則として\n        ビザに有効期限がある方",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　査証、ボランティア派遣機関等の証明、ボランティアの\n　参加同意書等の写し"]
[]
[]
[]
[]
[]
[null,null,null,null,null,"④",null,"　被保険者が外国に赴任している間に当該被保険者との身\n  分関係が生じた方であって、②と同等と認められる方\n　　[具体例]\n　　　・海外赴任中に生まれた被保険者の子供\n　　　・海外赴任中に現地で結婚した配偶者\n　　　・海外赴任中に縁組を結んだ特別養子",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　出生や婚姻等を証明する書類等の写し"]
[]
[]
[]
[]
[]
[null,null,null,null,null,"⑤",null,"　①から④までに掲げる者のほか、渡航目的その他の事情を\n　考慮して日本国内に生活の基礎があると認められる方\n　　[具体例]\n　　　・留学等の理由で渡航する被扶養者の海外赴任中に\n　　　　生まれた子供等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　※個別に判断"]

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[]
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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,"和暦","性別","月額","続柄"]
[null,null,null,"常務理事",null,null,null,"事務長",null,null,null,"部  長",null,null,null,"副部長･次長",null,null,null,"担当者",null,null,null,null,null,"5．昭和","1．男",58,"父　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"7．平成","2．女",68,"母　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"9．令和",null,78,"祖父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,88,"祖母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,98,"曾祖父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,104,"曾祖母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,110,"養父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,118,"養母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,126,"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,134,"夫　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,142,"妻　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,150,"長男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,160,"二男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,170,"三男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,180,"四男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,190,"五男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,200,"六男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,220,"七男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,240,"養子"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,260,"子"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,280,"長女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,300,"二女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,320,"三女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,340,"四女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,360,"五女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,380,"六女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,410,"七女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,440,"養女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,470,"子"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,500,"兄　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,530,"姉　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,560,"弟　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,590,"妹　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,620,"孫ー男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,650,"孫ー女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,680,"曾孫ー男"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,710,"曾孫ー女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,750,"伯父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,790,"伯母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,830,"叔父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,880,"叔母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,930,"甥　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,980,"姪　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1030,"義父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1090,"義母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1150,"義祖父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1210,"義祖母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1270,"義兄"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1330,"義姉"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1390,"義弟"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"義妹"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"義曾祖父"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"義曾祖母"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"子の夫"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"子の妻"]
[null,null,null,null,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"]