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[{"$nulls":10},"编号："]
["基本养老保险关系转移接续申请表"]
[]
["姓  名",null,"性 别",null,"公民身份号码"]
[]
[]
["原个人编号",null,"户籍所在地"]
["原参保   所在地  区名称",{"$nulls":3},"原参保地社   保机构行政  区划代码"]
["原参保地社保机构名称",{"$nulls":3},"原参保地社保机构联系电话"]
["原参保地  社保机构  地址",{"$nulls":4},"原参保地社保机构邮政编码"]
[]
[]
["参保单位（章）:",{"$nulls":3},"    申请人（签字）："]
["     联系电话：",{"$nulls":3},"    联系电话："]
[null,"  年  月  日",null,null,"年  月  日"]
[]
["（落款中的参保单位和申请人，二选一即可）"]