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["博白县计划生育情况审查表"]
["博白县卫生和计划生育局编制",{"$nulls":4},"            联系电话:"]
["姓    名",null,"性别","出生年月","现工作单位或家庭住址",null,"登记结婚\n年月","户口性质","婚姻状况"]
[{"$nulls":8},"未婚 初婚  再婚 离异"]
["配偶姓名",{"$nulls":7},"未婚 初婚  再婚 离异"]
["生 育 及 收 养 子 女 情 况",{"$nulls":4},"生育证审批机关或违法生育处理情况[含党纪、政纪处理等]","节 育 情 况"]
["胎 次","姓    名","性别","出生年月","是否属政策内生育",null,"手术时间"]
["第一胎",{"$nulls":5},"手术类型"]
["第二胎",{"$nulls":5},"手术医院"]
["第三胎",{"$nulls":5},"审查原因","博白县教师招聘"]
["第四胎",{"$nulls":5},"女方近期妇检时间、结果"]
["被审查人工作单位审查意见",{"$nulls":4},"配偶工作单位或村(居)委会审查意见"]
[]
["审核人:            年  月  日",{"$nulls":4},"审核人:                年  月  日"]
["被审查人户口所在地乡镇计生服务站\n审查意见",{"$nulls":4},"博白县卫生和计划生育局审核意见"]
[]
["审核人:               年  月  日",{"$nulls":4},"审核人:                   年  月  日"]
[]
["  说明:1、此表由被审查人如实填写；2、被审查人必须提供身份证、结婚证（含离婚证、离婚协议）、户口簿（含配偶、子女）、生育证、出生证、收养证、节育手术证、妇检记录、行政处理及交抚养费凭证等原件查验；3、审查人审核原件后，必须签名和加盖单位公章。意见栏不能写“情况属实”，必须明确被审查人生育几个孩子，有无违法生育行为，是否接受过党纪、政纪处分等；4、不尽事宜，咨询电话：0775－8320553"]

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