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釜堀行政書士事務所
3
sRGB IEC61966-2.1
(自認書)
(自認書)
記入例
記入例
記入例
記入例
※保管場所の所有者又は管理者に 作成してもらいます
※保管場所の所有者又は管理者に 作成してもらいます
令和
令和
令和 のコピー
令和
令和 のコピー 2
令和
福岡県福岡市南区井尻1-37-32-305
福岡県福岡市南区井尻1-37-32-305
行政書士 小池 友紀
行政書士 小池 友紀
自認書では、この欄に記載しません
自認書では、この欄に記載しません
自認書の場合、この欄には記載しません
自認書の場合、この欄には記載しません
〇 △ □
〇 △ □
福岡市中央区天神●丁目■番▲号 No.7
福岡市中央区天神●丁目■番▲号 No.7
福岡 一郎
福岡 一郎
福岡市中央区天神〇丁目△番□号 のコピー
福岡市中央区天神〇丁目△番□号
092 123 4567
092 123 4567
同上
同上
同上 のコピー
同上
親と子
親と子
元 10 1 2 9 30
元 10 1 2 9 30
〒810 - 0001
〒810 - 0001
000 - 1234 - 5678
000 - 1234 - 5678
福岡市中央区天神〇丁目△番□号
福岡市中央区天神〇丁目△番□号
811 - 0001
811 - 0001
福岡 一郎
福岡 一郎
自認書の作成日です。
自認書の作成日です。
自動車保管場所証明申請書の「自動車の保管場所の位置」 と同じ住所を記入します。
自動車保管場所証明申請書の「自動車の保管場所の位置」 と同じ住所を記入します。
自動車保管場所証明申請書の申請者欄と 同じ住所・氏名・電話番号を記入します。
自動車保管場所証明申請書の申請者欄と 同じ住所・氏名・電話番号を記入します。
保管場所の契約者と使用者が異なる場合 に記入します。同じ場合は記入不要です。。
保管場所の契約者と使用者が異なる場合 に記入します。同じ場合は記入不要です。。
申請の日から1ヶ月以上の期間が必要。
申請の日から1ヶ月以上の期間が必要。
【個人】 保管場所の所有者・管理者の住所・氏名を記入します。 【法人】 保管場所の所有者・管理者の住所・法人名・ 代表者氏名を
【個人】 保管場所の所有者・管理者の住所・氏名を記入します。 【法人】 保管場所の所有者・管理者の住所・法人名・ 代表者氏名を記入します。
【個人】 住民票の住所・氏名を記入します ※自動車保管場所証明申請書の 申請者欄に記入した住所・氏名と同じ 【法人】 登記簿
【個人】 住民票の住所・氏名を記入します ※自動車保管場所証明申請書の 申請者欄に記入した住所・氏名と同じ 【法人】 登記簿等の住所・法人名・代表者氏名を記入します ※自動車保管場所証明申請書の 申請者欄に記入した住所・法人名・代表者氏名と同じ
保管場所の使用者と契約者が異なる場合、 該当する番号に〇印を付けます。 その他は、( )内に親と子、夫と妻、 会社と
保管場所の使用者と契約者が異なる場合、 該当する番号に〇印を付けます。 その他は、( )内に親と子、夫と妻、 会社と社員など両者の関係を記入します。
所有者等に押印してもらいます。 法人の場合は、代表者印又は社印。
所有者等に押印してもらいます。 法人の場合は、代表者印又は社印。
日中に連絡をとることができる 電話番号(携帯番号等)を記入。
日中に連絡をとることができる 電話番号(携帯番号等)を記入。
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2020-04-21T19:04:17+09:00
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