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["（参考様式第７号）"]
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["平成",null,null,null,null,26,null,null,null,null,null,"年度",null,null,null,null,null,"環境保全型農業直接支払交付金交付申請書"]
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[]
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[]
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["北陸農政局長",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"殿"]
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[null,null,"　環境保全型農業直接支払交付金の交付を受けたいので、環境保全型農業直接支援対策実施要綱（平成23年４月１日付け22生産第10953号農林水産事務次官依命通知）の別紙１第２の１の規定に基づき、環境保全型農業直接支援対策実施要領（平成23年４月１日付け22生産第10954号生産局長通知。以下「実施要領」という。）第１の５の（1）により提出した実施計画書に記載した取組面積のうち対象活動が履行された面積について、実施要領第１の４の（３）により算定される交付額の交付を申請します。"]
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[null,null,"　また、別紙「交付申請に関する誓約事項」について誓約します。",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,"申請年月日",null,null,null,null,null,null,null,2014,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日"]
[]
[]
["交付申請者欄",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請印"]
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[null,null,null,"氏名又は\n法人・組織名",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,null,null,null,null,null,null,null,"印"]
[]
[]
[]
[]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"経営形態",null,null,null,null,"個人",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
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[null,null,null,"代表者氏名\n（法人・組織\nのみ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"集落営農（共販）"]
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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,null,"農業者グループ"]
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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,null,"法人"]
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[null,null,null,"住所",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,"富山",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"都道\n府県",null,null,null,null,"南砺",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市区\n町村"]
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[null,null,null,"電話",null,null,null,null,null,null,null,null,null,null,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"]
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["環境管理コード（右づめ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"振込口座について以下のいずれかにチェックしてください"]
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[null,null,3,null,2,null,0,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"F3-1&\"年度の本交付金と同様の口座を使用（左下の交付金の振込口座欄は記入不要です）\"","v":"25年度の本交付金と同様の口座を使用（左下の交付金の振込口座欄は記入不要です）"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
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["前年度の環境管理コードをお持ちの方は必ず記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"F3-1&\"年度の経営所得安定対策交付金と同様の口座を使用（左下の交付金の振込口座欄は記入不要です）\"","v":"25年度の経営所得安定対策交付金と同様の口座を使用（左下の交付金の振込口座欄は記入不要です）"}]
[]
[]
[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,{"$f":"F3-1&\"年度の経営所得安定対策交付金の交付申請者管理コード\"","v":"25年度の経営所得安定対策交付金の交付申請者管理コード"}]
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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,"地域協議会等管理コード"]
["個人情報の取扱いの確認"]
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["「個人情報の取扱い」に記載された内容について"]
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[null,null,null,null,null,null,null,null,null,null,"　同意する",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"上記と異なる口座を使用（左下の交付金の振込口座欄に記入してください）",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,true]
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["交付金の振込口座",null,"金融機関（ゆうちょ銀行以外）"]
[null,null,"金融機関コード（数字４ケタ）",null,null,null,null,null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（選択してください）"]
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[null,null,"支店コード（数字３ケタ）",null,null,null,null,null,null,null,null,"支店名"]
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[]
[null,null,"預金種別（該当のものをチェックしてください）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口座番号（７ケタに満たない場合は、右づめで記入）"]
[null,null,null,null,"普通",null,null,null,null,null,"当座",null,null,null,null,null,"別段",null,null,null,null,null,"通知",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
[null,null,"口座名義人"]
[null,null,"フリガナ"]
[null,null,"漢字"]
[]
[null,null,"ゆうちょ銀行",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〈担当者記入欄〉"]
[null,null,"記号（６ケタ目がある場合は※部分に記入）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,"【市町村】",null,null,null,null,null,null,null,null,null,null,"【地域センター】"]
[]
[]
[null,null,"口座名義人"]
[null,null,"フリガナ"]
[null,null,"漢字"]
[]
["（添付書類）"]
[1,null,"共同販売経理を行っている集落営農の場合は、規約、構成員名簿及び共同販売経理を確認することができる書類（集落営農（代表者）名義の預金通帳の写し等）"]
[2,null,"農業者グループの場合は、規約及び構成員名簿"]
[null,null,null,"口座情報の記載を間違えると入金できません。"]
[null,null,null,"振込口座欄を記入された方は、必ず交付金の振込口座に該当する「通帳表紙裏ページ」のコピーを添付してください。"]
["（参考様式第７号別紙）"]
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["（参考様式第７号別添）"]
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["個人情報の取扱い"]