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["（様式第3号）",null,null,null,"令和6年4月改定",{"$nulls":25},"市町村控①"]
["全国町村会　災害対策費用保険　災害発生報告書"]
[]
["損害保険ジャパン 株式会社 御中\n災害対策費用保険事故について、次のとおり報告いたします。\nまた、私は本件事故について、損害の費用対象である者の個人情報取扱について、当事者間で以下の事項に合意していることを通知いたします。\n１．貴社が、保険金の支払、支払の判断のために、上記の個人情報を取得・利用すること。\n２．貴社が上記１．の利用目的のために、本件事故に関する関係先等に提供あるいは登録を行い、また、これらの者から提供を受けることがあること。"]
[]
[]
[]
[]
[]
[]
[{"$nulls":24},"都","道","府","県"]
[]
[{"$nulls":24},"　"]
["令和",null,null,null,"年",null,null,null,"月",null,null,null,"日",{"$nulls":11},"町（市）長",{"$nulls":6},"　"]
[{"$nulls":24},"村長",{"$nulls":4},"氏名"]
[{"$nulls":36},"押印省略可"]
["加入依頼書の受付日",{"$nulls":6},"令和",{"$nulls":12},"契　　約\nプラン型",{"$nulls":8},"地震・噴火・津波OP(ﾌﾟﾙﾀﾞｳﾝ）"]
[{"$nulls":12},"年",null,null,"月",null,null,"日",{"$nulls":12},"無"]
["災害救助法の適用\nﾌﾟﾙﾀﾞｳﾝあり→",{"$nulls":6},"③適用されなかった。⇒以下続けてご記入ください。",{"$nulls":33},"⇐"]
[]
["災害の発生原因"]
[]
[]
[]
["避難指示等を\n発令した日時\nおよび解除し\nた日時\n＊避難指示等の発令が複数以上の場合は別紙（様式自由）に記入のうえ、添付してください。",{"$nulls":5},"ﾌﾟﾙﾀﾞｳﾝで選んでください。↓",{"$nulls":9},"＜発令日時＞",{"$nulls":12},"＜解除日時＞"]
[{"$nulls":7},"①避難指示の発令",{"$nulls":7},"令和",{"$nulls":12},"令和"]
[{"$nulls":16},"年",null,"月",null,"日","午前",null,"時",null,"分","⇒",null,null,"年",null,"月",null,"日","午前",null,"時",null,"分"]
[{"$nulls":21},"午後",null,"時",null,"分",{"$nulls":8},"午後",null,"時",null,"分"]
[]
[]
["設置数",{"$nulls":6},"避難所設置数",{"$nulls":5},"（",{"$nulls":5},")","か所"]
[]
["応急救助に\n関わった職員数",{"$nulls":6},"超過勤務手当支給対象者数"]
[{"$nulls":7},"(",{"$nulls":8},")","名"]
[]
["災害対応の状況"]
{"$rows_empty":13}
["災害担当\n連絡先",{"$nulls":5},"所在地",null,null,"〒"]
[{"$nulls":6},"担当部署",{"$nulls":16},"ＴＥＬ"]
[{"$nulls":6},"担当者名",{"$nulls":16},"ﾒｰﾙｱﾄﾞﾚｽ"]
["災害救助費明細",{"$nulls":6},"(注)避難所設置の場所（施設名、所在地）等災害救助費用の詳細について、保険会社が損害額の算定上、必要と判断し該当書類、資料の提出を求めた場合は、遅滞なく提出し、損害の調査にご協力ください。"]
[]
["区　分",{"$nulls":5},"員　数　(人）",{"$nulls":5},"金　額　(円）",{"$nulls":7},"根　拠",{"$nulls":10},"支払限度"]
["避難所の設置\n（福祉避難所を含みます）",{"$nulls":8},"延人数",{"$nulls":21},"1人1日あたり340円もしくは\n1事故10万円のどちらか高い金額を限度とした実費",{"$nulls":9},"⇐"]
[]
[{"$nulls":31},"（福祉避難所の実費加算は除きます）"]
["炊き出しその他に\nよる食品給与",{"$nulls":8},"延人数",{"$nulls":21},"１人１日あたり\n1,230円以内の実費"]
[]
[]
["飲料水給与",{"$nulls":8},"延人数",{"$nulls":21},"実費"]
[]
[]
["被服寝具その他\n生活必需品\n給与または貸与",{"$nulls":8},"世帯数",{"$nulls":21},"手引掲載の表をご覧くだ\nさい"]
[]
[]
["医療および助産",null,"医療",{"$nulls":6},"延人数",{"$nulls":21},"実費"]
[]
[]
[null,null,"助産",{"$nulls":6},"延人数",{"$nulls":21},"実費"]
[]
[]
["学用品の給与",null,"小学校児童",{"$nulls":6},"延人数",{"$nulls":21},"教科書代：実費\n文房具費等：１人あたり4,800円以内"]
[]
[]
[null,null,"中学校生徒",{"$nulls":6},"延人数",{"$nulls":21},"教科書代：実費\n文房具費等：１人あたり5,100円以内"]
[]
[]
[null,null,"高等学校\n等生徒",{"$nulls":6},"延人数",{"$nulls":21},"教科書代：実費\n文房具費等：１人あたり5,600円以内"]
[]
[]
["救助のための\n輸送費",{"$nulls":30},"実費",{"$nulls":9},"⇐"]
[]
["応急救助費",{"$nulls":30},"実費",{"$nulls":9},"⇐"]
[null,null,"賃金"]
[]
[null,null,"消防団"]
[]
[null,null,"旅費"]
[]
[null,null,"消耗品費"]
[]
[null,null,"燃料費"]
[]
[null,null,"食料費"]
[]
[null,null,"光熱水費"]
[]
["合計額",{"$nulls":11},{"$f":"SUM(M56:T99)","v":0}]
["保険金請求額",null,"避難指示の発令\n(合計額×支払割合）（円未満四捨五入）",{"$nulls":28},"ご契約プランによる\n１事故支払限度額"]
[null,null,"高齢者等避難の発令\n(合計額×支払割合）（円未満四捨五入）"]

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["①適用された。⇒(注)災害救助法が適用された場合は、補償の対象となりません。"]
["②第2条第2項のみが適用された。⇒(注)第2条2項が提要された場合は、国庫負担となる費用以外が補償対象となります。"]
["③適用されなかった。⇒以下続けてご記入ください。"]

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