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{"sheet":"別記様式第10","index":0,"n_rows":44,"n_cols":12,"rows_kept":44,"cut":false,"hidden":false,"merged":[[1,8,1,11],[4,7,4,11],[5,7,5,10],[18,5,18,6],[19,5,19,6],[20,5,20,6],[7,0,7,11],[9,0,11,11],[13,0,13,11]],"flags":["formulas_cached_only"]}
["別記様式第10"]
[{"$nulls":8},"令和　　年　　月　　日"]
["一般社団法人　環境共生住宅推進協議会"]
["会長　竹中　宣雄　殿"]
[{"$nulls":6},"代表提案者　"]
[{"$nulls":11},"㊞"]
[]
["平成３１年度住宅・建築物環境対策事業費補助金完了実績報告書"]
[]
["　令和　　年　　月　　日付けＫＫＪ３１発第　　　号をもって補助金の交付決定を受けた標記事業が完了したので、平成３１年度既存建築物省エネ化推進事業（省エネルギー性能の診断・表示に対する支援）補助金交付規程第１０の規定により、関係書類を添え、下記のとおり報告します。"]
[]
[]
[]
["記"]
[]
["　１．補助事業の名称　　既存建築物省エネ化推進事業"]
["　　　　　　　　　　　　（省エネルギー性能の診断・表示に対する支援）"]
[null,"事業名（　　　　　　　　　　　　　　　　　）"]
["　２．補助金の交付決定額及び精算額"]
["　　　　補助金の交付決定額",{"$nulls":6},"円（円で記入）"]
["　　　　補助金の精算額",{"$nulls":6},"円（円で記入）"]
["　４．補助事業の成果（添付書類のとおり）"]
[]
["　　（申請書類）"]
["　　　　１．交付決定通知書",{"$nulls":7},"（原本写し）"]
["　　　　２．補助金精算調書",{"$nulls":7},"（別紙１）"]
["　　　　３．科目別決算内訳",{"$nulls":7},"（別紙２）"]
["　　　　４．科目別決算内訳の明細",{"$nulls":7},"（別紙３）"]
[]
["　　（添付書類）"]
["　　　　１. 省エネ性能表示の普及に資する取り組み実施結果：その１",{"$nulls":7},"（実績様式３－１）"]
["　　　　２. 省エネ性能表示の普及に資する取り組み実施結果：その２",{"$nulls":7},"（実績様式３－２）"]
["　　　　３．事業着手確認書類",{"$nulls":7},"（任意様式１）"]
["　　　　　　・ＢＥＬＳ等第三者機関の引受承諾書"]
["　　　　　　・業務委託契約書または注文書・請書"]
["　　　　４. ＢＥＬＳ等第三者機関の省エネルギー性能に関する評価結果及び領収書",{"$nulls":7},"（任意様式２）"]
["　　　　５. 省エネルギー性能の診断・表示に係る費用（補助額）の支払いの事実を",{"$nulls":7}," (任意様式３)"]
["　　　　　　証明できるもの（領収書及び送金伝票等）"]
["　　　　６．省エネ性能表示の設置状況の写真等",{"$nulls":7},"（任意様式４）"]
["　　　　　　・省エネルギー性能評価結果の表示の写真（プレート等）"]
["　　　　７．その他確認に必要と思われるもの",{"$nulls":7},"（任意様式５)"]
[]
["　（記載上の注意）"]
["　　　　１．用紙の大きさは、日本工業規格で定めるＡ列４とし、縦位置とすること。"]

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[{"$nulls":6},"別紙１"]
[]
["補 助 金 精 算 調 書"]
[]
[]
["（単位：円）"]
["区　　分",{"$nulls":4},"金　　額","備　　考"]
["交付決定の内容",1,null,"補助事業に要する経費"]
[null,2,null,"補助金額"]
["補助金換算額",3,null,"精算対象支払額"]
[null,4,null,"精算補助金額"]
[5,"補助金不用額"]
[null,"5=2-4"]
[6,"補助金受入済額"]
[7,"差引受入未済額または超過額"]
[null,"7=6-4"]
[]
["※　精算補助金額は他の補助金の受け入れ未済額とすること。"]
["※　添付する他の様式と金額が整合していること。"]
{"$rows_empty":15}
[{"$nulls":4},"事業名："]

{"sheet":"別紙2","index":2,"n_rows":46,"n_cols":12,"rows_kept":46,"cut":false,"hidden":false,"merged":[[45,3,45,11],[15,0,15,8],[16,0,16,6],[19,0,19,8],[20,0,20,11],[21,0,21,11],[22,0,22,11],[8,5,9,5],[8,7,8,10],[9,7,9,10],[10,1,11,1],[23,0,23,11],[44,0,44,8],[1,0,1,8],[2,0,2,11],[3,0,3,8],[4,0,4,11],[12,0,14,0],[12,7,12,10],[13,7,13,10],[14,7,14,10],[6,0,11,0],[8,1,9,1],[5,0,5,1],[5,2,5,4],[5,6,5,11],[10,5,11,5],[10,7,10,10],[11,7,11,10],[6,1,7,1],[6,5,7,5],[6,7,6,10],[7,7,7,10]],"flags":["formulas_cached_only"]}
[{"$nulls":11},"別紙２"]
[]
["科 目 別 決 算 内 訳"]
[]
["(単位：円)"]
["事　業　区　分",null,"補助対象事業費",null,null,"補助率","補助金申請額"]
["内　訳","診断に要する費用\n(Ａ)","(",null,")","10/10","(",{"$nulls":4},")"]
[]
[null,"第三者認証・認定の\n取得に要する費用\n（Ｂ）","(",null,")","10/10","(",{"$nulls":4},"）"]
[]
[null,"表示に要する費用（Ｃ）","(",null,")","10/10","(",{"$nulls":4},"）"]
[]
[null,"補助金申請額合計\n（Ｄ）＝（Ａ＋Ｂ＋Ｃ）",null,0,null,null,null,0]
[null,"交付決定額\n(Ｅ)"]
[null,"変動増減\n(Ｄ-Ｅ)",{"$nulls":5},0]
[]
["　　補助対象建築物等における他の補助金の申請有無（予定含む）",{"$nulls":6},"□","あり","□","なし"]
["　　「あり」の場合は他の補助を受ける内容を具体的に記載した資料を添付して下さい。"]
[]
["（記載上の注意）"]
["１.  交付申請（または交付変更承認申請）に基づく交付決定額を上段（　）内に記載すること。"]
["２.  補助対象事業費には他の補助金を受けるものを含めることはできません。"]
["３.  実績報告書は円単位での作成となりますが、交付申請額の合計額は交付決定額以内の金額で千円未満を切り"]
["    捨てて記入して下さい。"]
{"$rows_empty":21}
[null,null,null,"事業名："]

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[{"$nulls":9},"別紙３"]
[]
["科目別決算内訳の明細"]
[]
[]
["１．省エネルギー性能の診断に要する費用"]
["(単位：円)"]
["補助対象棟数",null,null,"補助対象事業費",null,null,"補助率","補助金申請額"]
["(",null,")","(",null,")","10/10","(",null,")"]
["　　　　　　　　　"]
[]
["２．省エネルギー性能の第三者認証・認定の取得に要する費用"]
[{"$nulls":9},"(単位：円)"]
["補助対象棟数",null,null,"補助対象事業費",null,null,"補助率","補助金申請額"]
["(",null,")","(",null,")","10/10","(",null,")"]
["　　　　　　　　　"]
[]
["３．省エネルギー性能表示に要する費用"]
[{"$nulls":9},"(単位：円)"]
["補助対象棟数",null,null,"補助対象事業費",null,null,"補助率","補助金申請額"]
["(",null,")","(",null,")","10/10","(",null,")"]
["　　　　　　　　　"]
[]
[]
[]
[null,"注１．交付申請(又は交付変更承認申請）に基づく交付決定額を上段（　）内に記載すること。"]
[null,"注２．事業量の減少による減額があった場合はその変更内容および額の積算内訳を添付すること。"]
{"$rows_empty":14}
[{"$nulls":4},"事業名："]

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[{"$nulls":26},"（実績様式３-１・定額補助）"]
["省エネ性能表示の普及に資する取り組み実施結果：その１"]
["【定額補助】"]
[]
["事業名",{"$nulls":13},"代表提案者"]
[]
["１．省エネ性能表示（評価書、プレート等による表示）の実施結果"]
["主たる建物用途\n（具体的に記載して\nください）",{"$nulls":4},"使用形態\n（持ち家・\n賃貸・自社\n使用の別）",null,null,null,"表示方法",{"$nulls":5},"実施棟数（棟）"]
[{"$nulls":15},"ＢＥＬＳ",null,null,"ｅマーク",null,null,"その他",null,null,"合計"]
[]
[]
[]
["合計"]
[]
["２．省エネ性能表示の普及に資する取り組み実施結果"]
[]
["波及効果\n(人／年間)",null,"波及効果の根拠"]
[null,null,"対象人数(人)",{"$nulls":8},"効果率(%)[B]",null,null,"波及見込み人数(人)\n[C]=A×B",null,null,"実施結果に基く今後の対策"]
[null,null,"実施分\n[a]",null,null,"未実施分\n[b]",null,null,"合計\n[A]=a+b"]
[null,null,"令和　年　月",null,null,"令和　年　月",null,null,"一年間"]
[null,null,"令和　年　月",null,null,"令和　年　月"]
["□","見せる"]
[0,{"$nulls":7},0,{"$nulls":5},0]
[{"$nulls":8},0,{"$nulls":5},0]
["（人／年間）",{"$nulls":7},0,{"$nulls":5},0]
["□","学習"]
[0,{"$nulls":7},0,{"$nulls":5},0]
[{"$nulls":8},0,{"$nulls":5},0]
["（人／年間）",{"$nulls":7},0,{"$nulls":5},0]
["□","その他の特記すべき取り組み　（波及効果として人数に換算することが難しい取り組みなど）"]

{"sheet":"様式3-2(定額補助)","index":5,"n_rows":34,"n_cols":33,"rows_kept":34,"cut":false,"hidden":false,"merged":[[1,0,1,32],[2,0,2,32],[4,0,4,3],[4,4,4,17],[4,18,4,22],[4,23,4,32],[8,8,8,10],[8,11,8,31],[5,0,8,3],[25,0,25,1],[29,3,31,3]],"flags":["formulas_cached_only"]}
[{"$nulls":32},"（実績様式３-２・定額補助）"]
["省エネ性能表示の普及に資する取り組み実施結果：その２"]
["【定額補助】"]
[]
["事業名",{"$nulls":17},"代表提案者"]
["取り組み\n単位",null,null,null,"□","特定の建築物",{"$nulls":12},"１棟又は複数棟で実施"]
[{"$nulls":4},"□","特定の地域",{"$nulls":12},"街区・エリア単位など、複数棟でまとめて実施"]
[{"$nulls":4},"□","事業者単位",{"$nulls":12},"エリア限定なし（全国、所有物件）の複数棟にて実施"]
[{"$nulls":4},"□","その他",null,null,"（内容：",{"$nulls":23},"）"]
["■全体概要"]
{"$rows_empty":23}
["■実施体制"]

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["BELSプレート掲示写真",{"$nulls":4},"任意様式４"]
[{"$nulls":5},"①BELSプレート設置（拡大）"]
[{"$nulls":5},"撮影日：令和　年　月　日"]
[{"$nulls":5},"場所："]
[]
[{"$nulls":5},"内容："]
[]
[]
[]
[]
[]
[]
[{"$nulls":5},"②BELSプレート設置（近景）"]
{"$rows_empty":10}
[{"$nulls":5},"③BELSプレート設置（遠景）"]

{"sheet":"別記様式第12","index":7,"n_rows":36,"n_cols":11,"rows_kept":36,"cut":false,"hidden":false,"merged":[[9,0,11,10],[2,0,2,10],[14,7,14,10],[19,6,19,7],[6,4,6,7],[20,6,20,10],[33,1,33,2],[34,1,34,2],[35,1,35,2],[34,3,34,9],[35,3,35,9],[21,6,21,10],[24,6,24,9],[25,6,25,9],[22,6,22,10],[30,3,30,6],[30,7,30,9],[23,6,23,10],[28,1,31,2],[32,1,32,2],[32,3,32,9],[28,3,28,6],[28,7,28,9],[29,3,29,6],[29,7,29,9]],"flags":["formulas_cached_only"]}
["別記様式第12"]
[]
["請　　求　　書"]
[]
[]
[]
[null,null,null,"請求額　　金",{"$nulls":4},"円"]
[]
[]
["　ただし、令和　　年　　月　　日付、ＫＫＪ３１発第　　　　　号で交付決定のあった平成３１年度既存建築物省エネ化推進事業（省エネルギー性能の診断・表示に対する支援）に係る国庫補助金として、上記の金額を請求いたします。"]
[]
[]
[]
[]
[{"$nulls":7},"令和　　年　　月　　日"]
[]
["一般社団法人　環境共生住宅推進協議会"]
["会長　竹中　宣雄　殿"]
[]
[{"$nulls":5},"請求者　住所　","〒"]
[]
[]
[{"$nulls":5},"氏名又は名称　"]
[]
[{"$nulls":5},"代表者の職名・氏名　",{"$nulls":4},"印"]
[]
["＜ 振 込 先 ＞"]
[]
[null,"振込先",null,"銀行名",null,null,null,"支店名"]
[]
[null,null,null,"銀行コード",null,null,null,"支店コード"]
[]
[null,"預金種別",null,"普通　・　当座　・　別段　・　その他"]
[null,"口座番号(右詰)"]
[null,"口座名義(カナ)"]
[null,"口座名義(漢字)"]