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[null,"別記様式８"]
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[null,null,null,"ＥＴＣコーポレートカード紛失届"]
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[null,"東日本高速道路株式会社",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,"殿"]
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[null,null,null,null,null,null,null,null,null,null,null,null,"お客様番号",null,null,null,"（",null,null,null,null,null,"‐",null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"お客様の",null,null,null,"〒",null,null,null,"‐"]
[null,null,null,null,null,null,null,null,null,null,null,null,"おところ"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"お名前※",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[null,null,null,null,null,null,null,null,null,null,null,null,"ＴＥＬ",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,"法人（事業協同組合を含みます。）でお申込みの場合は、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"法人名および代表者名を記入してください。"]
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[null,"私は､貴社から貸与を受けているＥＴＣコーポレートカードを　　　　年 　月　 日に亡失しましたので、利用約款第１０条第１項に基づき、下記のとおり紛失届を提出するとともに、貴社において当該カードの無効登録をしていただきたくお願いいたします。"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記"]
[null,"①紛失したＥＴＣ",null,null,null,null,null,null,null,{"$f":"COUNTA(B30:I44)","v":0}]
[null,"コーポレートカードの枚数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,"②紛失したＥＴＣ",null,null,null,null,null,null,null,"③理由",null,null,null,null,null,null,"④状況",null,null,null,null,null,null,"⑤備考"]
[null,"コーポレートカードの番号",null,null,null,null,null,null,null,"（紛失・盗難・その他理由を",null,null,null,null,null,null,"（できる限り詳しく"]
[null,null,null,null,null,null,null,null,null,"明確に記入してください。）",null,null,null,null,null,null,"記入してください。）"]
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[null,"(注)",null,"⑤","…","事業協同組合である場合には、ETCコーポレートカードごとに当該カードを紛失等した組合員名を記入して下さい。"]
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[null,"入力漏れチェック未了\r\n（「入力漏れチェック」を押してください。）"]