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["附件2:"]
["常州市区灵活就业人员社会保险补贴申报表"]
["   年  第    季度"]
["申请人姓名",null,"性别",null,"身份证"]
["就业失业登记证",null,null,"联系电话 "]
["个人社会保险代码"]
["户籍地址",null,null,"家庭住址"]
["托管档案机构",null,null,"托管档案编号"]
["目前灵活就业简况"]
["编号","工作单位或工作地点",null,"工作岗位","工作时间","工资收入"]
[1]
[2]
[3]
["本次申请补贴起止日期","年   月——    年    月"]
["本人本次缴纳社会保险总额",null,null,"养老保险费"]
[{"$nulls":3},"医疗保险费"]
["以下内容由街道(乡镇）劳动保障所工作人员填写"]
["持就业失业登记证就业困难对象类别","1、“4050”人员",{"$nulls":3},"□"]
[null,"2、低保人员",{"$nulls":3},"□"]
[null,"3、城镇零就业家庭人员",{"$nulls":3},"□"]
[null,"4、农村零转移家庭人员",{"$nulls":3},"□"]
["申请人申请","申请人承诺：本人从事灵活就业，若虚构事实，隐瞒真相而申领了社会保险补贴，按规定承担相关法律责任。",null,"街道（乡镇）劳动保障所意见 单位（盖章）："]
[null,"申请人（签字）：",null,"经办人："]
[null,"年    月    日",null,"年   月   日"]
["劳动事务代理机构核定意见","本次核准社会保险补贴金额          元，其中：养老     元；医疗     元。"]
[null,"经办人：       ","单位（盖章）：",null,"       年    月    日"]
["备注：本表一式三份，劳动事务代理机构核定补贴标准后，本人、街道、劳动失业代理机构各存一份。"]

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