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["（様式１-１）"]
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[null,"寄　付　申　込　書"]
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[null,"　私立学校法第３条に規定する学校法人が設置する学校教育法第１条に規定する学校及び学校法人（私立学校法第６４条第４項の準学校法人を含む。）が設置する専修学校の教育若しくは研究に必要な費用又は基金に充てるために、下記のとおり寄付を申し込みます。"]
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[]
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[{"$nulls":6},"平成",null,"年",null,"月",null,"日"]
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[null,"日本私立学校振興・共済事業団"]
[null,"　理 事 長　河 田　悌 一　　殿"]
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[{"$nulls":5},"〒",null,null,"－"]
[{"$nulls":5},"寄付申込者"]
[{"$nulls":5},"住所"]
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[{"$nulls":5},"社名"]
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[{"$nulls":5},"代表者名"]
[{"$nulls":5},"（又は個人名）",{"$nulls":6},"印"]
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[null,"１","寄付金の額",null,null,"金",{"$nulls":6},"円"]
[null,"２","寄付金払込期日",null,null,null,"平成",null,"年",null,"月",null,"日"]
[null,"３","指定事項"]
[null,"　（１）学校法人名"]
[null,"　（２）その他特記事項"]
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[null,"４","確認事項"]
[null,"　当該寄付により、寄付によって設けられた設備を専属的に利用することその他特別の利益を受けることがありません。"]
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[]
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[null,"（注）","寄付者が法人の場合は、必ず法人としての寄付が確認できる印（法人登記印、代表者印、会社印等）を押印してください。"]
[]
[null,"（注）","学校法人を経由して提出してください。"]

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["（様式１-１）"]
[]
[null,"寄　付　申　込　書"]
[]
[null,"　私立学校法第３条に規定する学校法人が設置する学校教育法第１条に規定する学校及び学校法人（私立学校法第６４条第４項の準学校法人を含む。）が設置する専修学校の教育若しくは研究に必要な費用又は基金に充てるために、下記のとおり寄付を申し込みます。"]
[]
[]
[]
[{"$nulls":6},"平成","○","年",9,"月",30,"日"]
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[null,"日本私立学校振興・共済事業団"]
[null,"　理 事 長　河 田　悌 一　　殿"]
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[{"$nulls":5},"〒","000－0000"]
[{"$nulls":5},"寄付申込者","東京都千代田区富士見\n　○○－△△－□□"]
[{"$nulls":5},"住所"]
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[{"$nulls":5},"社名","私学事業団株式会社"]
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[{"$nulls":5},"代表者名","代表取締役\n　○　山　◇　郎"]
[{"$nulls":5},"（又は個人名）",{"$nulls":6},"印"]
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[null,"１","寄付金の額",null,null,"金",123456789,{"$nulls":5},"円"]
[null,"２","寄付金払込期日",null,null,null,"平成","○","年",10,"月",31,"日"]
[null,"３","指定事項"]
[null,"　（１）学校法人名",null,null,null,"東西学園"]
[null,"　（２）その他特記事項",null,null,null,"東西大学創立80周年記念事業"]
[]
[null,"４","確認事項"]
[null,"　当該寄付により、寄付によって設けられた設備を専属的に利用することその他特別の利益を受けることがありません。"]
[]
[]
[]
[null,"（注）","寄付者が法人の場合は、必ず法人としての寄付が確認できる印（法人登記印、代表者印、会社印等）を押印してください。"]
[]
[null,"（注）","学校法人を経由して提出してください。"]