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["住房公积金提取申请表"]
["提取记录单编号：              "]
["姓名",null,"公积金账号"]
["证件类型",null,"证件号码"]
["单位名称",null,null,"联系电话"]
["提取方式","    □约定提取     □非约定提取"]
["转入账户信息","姓名","开户行","账户类型",null,"账号"]
[]
["提取原因","□非按揭购买自住住房          □在本市租房自住          □非本市户口与单位解除劳动关系\n\n□偿还购房贷款本息            □离休、退休              □下岗且满一定年龄\n\n□征地补偿购买增大面积住房     □出境定居               □死亡或被宣告死亡\n\n□建造自住住房                □离职且户口调离本市      □其他\n                             \n□翻建自住住房                □完全丧失劳动能力并与单位解除劳动关系\n\n□大修自住住房"]
[]
[]
[]
[]
[]
[null,"其他的注明原因："]
["本次提取总金额（大写）： ",null,null,"千","百","十","万","千","百","十","元","角","分"]
[]
["      本人保证此次用于申请提取住房公积金的所有材料真实，如有虚假，本人愿意无条件返还住房公积金相关款项，并依法承担相应的法律责任。另本人同意住房公积金业务经办机构通过人民银行征信系统等渠道核查本人提取住房公积金的相关申请材料。\n\n\n                                    申请人签名： \n                                    年    月    日",null,null,"        经审核，情况属实，资料复印件与原件相符。\n\n\n                                单位盖章（公章）：\n                                  年    月    日"]
["注：1、首次提取的，无须填写提取记录单编号；2、大、小写金额可到经办网点查询余额后再填写；3、本表已填项目需修改的，由申请人本人在修改处签名、按手指模确认。"]

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