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["灵活就业人员医保停保登记表"]
[]
["姓名*",null,"民族",null,"移动电话*"]
["证件类型*",null,"证件号码*"]
["停保时间*","年          月     "]
["  本人承诺，所填写内容和提供材料真实准确有效，否则承担相应的法律责任。\n\n                                           承诺人（签名） ：\n\n                                           日期：    年   月   日"]
[]
["备注：停保时间当月，需至税务缴纳医疗保险费用。"]