{"text_format":"1","workbook":"xlsx","n_sheets":1,"sheets":["人身事故証明書入手不能理由書"],"not_rendered":{"charts":0,"images":0,"macros":0,"external_links":0,"defined_names":3,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"人身事故証明書入手不能理由書","index":0,"n_rows":121,"n_cols":28,"rows_kept":121,"cut":false,"hidden":false,"merged":[[114,25,116,25],[117,4,119,6],[117,7,119,13],[117,14,119,17],[117,18,119,26],[112,22,113,22],[112,23,113,23],[112,24,113,24],[112,25,113,25],[112,26,113,26],[114,4,116,6],[114,7,116,13],[114,14,116,17],[114,19,116,19],[114,20,116,24],[112,4,113,6],[112,7,113,13],[112,14,113,17],[112,18,113,19],[112,20,113,20],[112,21,113,21],[104,25,106,25],[107,4,109,6],[107,7,109,13],[107,14,109,17],[107,18,109,26],[110,3,119,3],[110,4,111,6],[110,7,111,17],[110,18,111,19],[110,20,111,26],[102,22,103,22],[102,23,103,23],[102,24,103,24],[102,25,103,25],[102,26,103,26],[104,4,106,6],[104,7,106,13],[104,14,106,17],[104,19,106,19],[104,20,106,24],[102,4,103,6],[102,7,103,13],[102,14,103,17],[102,18,103,19],[102,20,103,20],[102,21,103,21],[94,25,96,25],[97,4,99,6],[97,7,99,13],[97,14,99,17],[97,18,99,26],[100,3,109,3],[100,4,101,6],[100,7,101,17],[100,18,101,19],[100,20,101,26],[92,22,93,22],[92,23,93,23],[92,24,93,24],[92,25,93,25],[92,26,93,26],[94,4,96,6],[94,7,96,13],[94,14,96,17],[94,19,96,19],[94,20,96,24],[92,4,93,6],[92,7,93,13],[92,14,93,17],[92,18,93,19],[92,20,93,20],[92,21,93,21],[84,25,86,25],[87,4,89,6],[87,7,89,13],[87,14,89,17],[87,18,89,26],[90,3,99,3],[90,4,91,6],[90,7,91,17],[90,18,91,19],[90,20,91,26],[82,22,83,22],[82,23,83,23],[82,24,83,24],[82,25,83,25],[82,26,83,26],[84,4,86,6],[84,7,86,13],[84,14,86,17],[84,19,86,19],[84,20,86,24],[82,4,83,6],[82,7,83,13],[82,14,83,17],[82,18,83,19],[82,20,83,20],[82,21,83,21],[74,25,76,25],[77,4,79,6],[77,7,79,13],[77,14,79,17],[77,18,79,26],[80,3,89,3],[80,4,81,6],[80,7,81,17],[80,18,81,19],[80,20,81,26],[72,22,73,22],[72,23,73,23],[72,24,73,24],[72,25,73,25],[72,26,73,26],[74,4,76,6],[74,7,76,13],[74,14,76,17],[74,19,76,19],[74,20,76,24],[72,4,73,6],[72,7,73,13],[72,14,73,17],[72,18,73,19],[72,20,73,20],[72,21,73,21],[63,21,66,22],[63,23,66,26],[67,2,69,6],[67,7,69,26],[70,2,119,2],[70,3,79,3],[70,4,71,6],[70,7,71,17],[70,18,71,19],[70,20,71,26],[63,13,66,13],[63,14,66,15],[63,16,66,16],[63,17,66,17],[63,18,66,18],[63,19,66,20],[63,2,66,6],[63,7,66,8],[63,9,66,9],[63,10,66,10],[63,11,66,11],[63,12,66,12],[55,2,56,7],[55,9,56,25],[58,2,58,4],[58,9,58,15],[58,20,58,21],[61,1,61,27],[52,2,52,5],[52,21,52,26],[53,2,53,5],[53,21,53,26],[54,2,54,5],[54,21,54,26],[47,21,49,23],[47,24,49,26],[49,2,50,18],[51,2,51,5],[51,6,51,20],[51,21,51,26],[37,2,37,3],[37,7,37,9],[37,13,37,25],[39,13,39,25],[41,2,43,26],[46,21,46,23],[46,24,46,26],[28,5,29,25],[33,2,33,3],[33,14,33,16],[33,20,33,21],[35,2,35,3],[35,13,35,25],[25,20,27,21],[25,22,27,22],[25,23,27,23],[25,24,27,24],[25,25,27,25],[25,26,27,26],[25,2,27,5],[25,6,26,8],[25,9,26,10],[25,11,26,13],[25,14,26,15],[25,16,27,19],[13,6,13,7],[14,2,21,5],[15,6,15,7],[16,11,18,25],[19,6,19,7],[20,11,22,25],[0,1,1,27],[3,1,3,10],[6,2,6,26],[9,6,9,7],[11,6,11,7],[12,2,12,5]]}
[null,"　人身事故証明書入手不能理由書　"]
[]
[]
[null," ",null,null,null,null,null,null,null,null,null,"御中"]
[]
[null,"■　人身事故扱いの交通事故証明書が入手できなかった理由をお教えください。"]
[null,null,"（人身事故扱いの交通事故証明書が添付されていても、被害者の方のお名前がない場合は、記入してください。）"]
[]
[]
[null,null,null,null,null,null,"◌",null,"受傷が軽微で、検査通院のみ（予定を含む）であったため"]
[]
[null,null,null,null,null,null,"◌",null,"受傷が軽微で、短期間で治療を終了した（もしくは終了予定の）ため"]
[null,null,"理　由"]
[null,null,null,null,null,null,"◌",null,"公道以外の場所（駐車場、私有地など）で発生した事故のため"]
[null,null," ※　該当する項目\n 　に○印をしてく\n 　ださい。\n ※　複数に該当す\n 　る場合は、すべ\n　 てに○印をして\n　 ください。",null,null,null,"　"]
[null,null,null,null,null,null,"◌",null,"事故当事者の事情（理由を具体的に記載してください。）"]
[null,null,null,null,null,null,null,null,null,"【理由】",null,""]
[]
[]
[null,null,null,null,null,null,"◌",null,"その他（理由を具体的に記載してください。）"]
[null,null,null,null,null,null,null,null,null,"【理由】",null,""]
[]
[]
[]
[null,null,"◆　警察へ、事故発生の届出を行っている場合には、以下に記載してください。"]
[null,null,"届出警察",null,null,null,"",null,null,"警察",null,"",null,null,"担当官",null,"届出年月日",null,null,null,"",null,"年","","月","","日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"（判明している場合）"]
[null,null,"裏面へ",null,"☞","   交通事故証明書が発行されていない場合、または発行されている交通事故証明書にお名前が\n ない場合に限り、裏面の事故当時者、発生日時、発生場所等を記入してください。"]
[]
[]
[null,"■　人身事故の事実を確認するため、関係者の記名・押印をお願いします。"]
[null,null,"◆　上記理由により人身事故証明書は取得していませんが、人身事故の事実に相違ありません。"]
[null,null,"◌",null,"当事者",null,null,null,null,null,null,"住所：",null,"〒",null,null,null,null,"記載日",null,null,null,"年",null,"月",null,"日"]
[]
[null,null,"◌",null,"目撃者"]
[]
[null,null,"◌",null,"その他（",null,null,"",null,null,"）","氏名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㊞"]
[null,null,null,"※　該当する項目に"]
[null,null,null,null,null,"〇印をしてください",null,null,null,null,null,"電話："]
[]
[null,null,"(注)当欄は、賠償を求める側が、直接、自賠責保険に請求（法第１６条請求）する場合には、保険契約者側（契約\n     者、運転者など）の方、または目撃者の方がご記入ください。賠償をした側が請求（法第１５条請求）する場\n     合には、賠償を受けた側の方、または目撃者の方がご記入ください。"]
[null," "]
[]
[]
[]
[null,"（保険会社使用欄）　　　該当する□のすべてに✓する。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"責任者",null,null,"担当者"]
[null,"□","人身事故としての警察への届出の必要性について、説明しました。"]
[]
[null,"□","請求関係書類の確認により、または以下の調査・確認により、人身事故の事実に相違ないことを確認しました。"]
[]
[null,null," ◆　確認日",null,null,null," ◆　確認先",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ◆　確認方法"]
[null,null,"　　月　 年　 日",null,null,null," □病院 □目撃者 □運転者 □被害者 □修理工場 □その他（　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　□電話　□文書　□面談"]
[null,null,"　　月　 年　 日",null,null,null," □病院 □目撃者 □運転者 □被害者 □修理工場 □その他（　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　□電話　□文書　□面談"]
[null,null,"　　月　 年　 日",null,null,null," □病院 □目撃者 □運転者 □被害者 □修理工場 □その他（　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　□電話　□文書　□面談"]
[null,null,"◆　その他・特記事項"]
[]
[]
[null,"【","事案情報",null,null,null,"被害者名：",null,null,"",null,null,null,null,null,null,null,"事故日：",null,null,"",null,"年","","月","","日","】"]
[]
[null,"○交通事故概要記入欄"]
[null,"（物件事故扱いの交通事故証明書にお名前が記載されている場合は、以下の項目は記載不要です。）"]
[]
[null,null,"発生年月日時",null,null,null,null,"",null,"年","","月","","日"," ",null,"","時","","分頃",null,"天候",null," "]
[]
[]
[]
[null,null,"発生場所",null,null,null,null,""]
[]
[]
[null,null,"当　　事　　者","甲","住所",null,null,"",null,null,null,null,null,null,null,null,null,null,"電話",null,"(       )"]
[]
[null,null,null,null,"氏名",null,null,"",null,null,null,null,null,null,"生年月日",null,null,null,"",null,"年","","月","","日","","才"]
[]
[null,null,null,null,"自賠責保\n険契約先",null,null,"",null,null,null,null,null,null,"自賠責保険\n証明書番号",null,null,null,null,"第","",null,null,null,null,"号"]
[]
[]
[null,null,null,null,"登録番号",null,null,"",null,null,null,null,null,null,"事故時の状況",null,null,null,"運転・同乗（甲・乙）・歩行・その他"]
[]
[]
[null,null,null,"乙","住所",null,null,"",null,null,null,null,null,null,null,null,null,null,"電話",null,"(       )"]
[]
[null,null,null,null,"氏名",null,null,"",null,null,null,null,null,null,"生年月日",null,null,null,"",null,"年","","月","","日","","才"]
[]
[null,null,null,null,"自賠責保\n険契約先",null,null,"",null,null,null,null,null,null,"自賠責保険\n証明書番号",null,null,null,null,"第","",null,null,null,null,"号"]
[]
[]
[null,null,null,null,"登録番号",null,null,"",null,null,null,null,null,null,"事故時の状況",null,null,null,"運転・同乗（甲・乙）・歩行・その他"]
[]
[]
[null,null,null,"丙","住所",null,null,"",null,null,null,null,null,null,null,null,null,null,"電話",null,"(       )"]
[]
[null,null,null,null,"氏名",null,null,"",null,null,null,null,null,null,"生年月日",null,null,null,"",null,"年","","月","","日","","才"]
[]
[null,null,null,null,"自賠責保\n険契約先",null,null,"",null,null,null,null,null,null,"自賠責保険\n証明書番号",null,null,null,null,"第","",null,null,null,null,"号"]
[]
[]
[null,null,null,null,"登録番号",null,null,"",null,null,null,null,null,null,"事故時の状況",null,null,null,"運転・同乗（甲・乙）・歩行・その他"]
[]
[]
[null,null,null,"丁","住所",null,null,"",null,null,null,null,null,null,null,null,null,null,"電話",null,"(       )"]
[]
[null,null,null,null,"氏名",null,null,"",null,null,null,null,null,null,"生年月日",null,null,null,"",null,"年","","月","","日","","才"]
[]
[null,null,null,null,"自賠責保\n険契約先",null,null,"",null,null,null,null,null,null,"自賠責保険\n証明書番号",null,null,null,null,"第","",null,null,null,null,"号"]
[]
[]
[null,null,null,null,"登録番号",null,null,"",null,null,null,null,null,null,"事故時の状況",null,null,null,"運転・同乗（甲・乙）・歩行・その他"]
[]
[]
[null,null,null,"戊","住所",null,null,"",null,null,null,null,null,null,null,null,null,null,"電話",null,"(       )"]
[]
[null,null,null,null,"氏名",null,null,"",null,null,null,null,null,null,"生年月日",null,null,null,"",null,"年","","月","","日","","才"]
[]
[null,null,null,null,"自賠責保\n険契約先",null,null,"",null,null,null,null,null,null,"自賠責保険\n証明書番号",null,null,null,null,"第","",null,null,null,null,"号"]
[]
[]
[null,null,null,null,"登録番号",null,null,"",null,null,null,null,null,null,"事故時の状況",null,null,null,"運転・同乗（甲・乙）・歩行・その他"]
[]
[]
[null,null,null,"※　上記に事故当事者が記入できない場合には、別紙に必要事項を記載してください。"]