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["淮安市社会保险人员退休变更医保费用申报表"]
["单位名称：(盖章）",{"$nulls":3},"单位编号:"]
["个人\n编号","姓名","身份证号码","退休前\n工资","变更\n时间","费率\n（8%）","视同缴费月数","实际缴费月数","应缴月数","应缴基本\n医疗保险费","月退休金\n（养老金）","备注"]
{"$rows_empty":11}
["合  计"]
["说明：此表一式两份，参保人员退休变更及退休人员新参保时填写此表，单位一份，征管中心一份。\n      "]
[]
["单位负责人：",null,"经办人:",null,null,"电话:",null,"征管中心审核人:",null,null,"   年  月   日"]