fanzherong
/
baozhangfang


			
				
					
						
						
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							<%-- 淮安市市区公租房实物配租复核申请表（城镇住房困难家庭）--%>
<%@ page language="java" import="java.util.*" pageEncoding="UTF-8"%>
<jsp:include page="../../common/include.jsp" />
<%
String path = request.getContextPath();
String basePath = request.getScheme()+"://"+request.getServerName()+":"+request.getServerPort()+path+"/";
%>
<%String securityPersonApplyId = request.getParameter("securityPersonApplyId");%>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
  <head>
	<script type="text/javascript" src="<%=basePath%>/js/jquery.jqprint.js"></script>
  <style>
        * {
            padding: 0;
            margin: 0;
        }
        .setunderline{
            display: inline-block;
            border-bottom: 1px solid #000;
            min-width: 150px;
        }
        .table1 table td {
            text-align: center;
        }
        .table1 table:last-child tr td{
            border-bottom: 0 none;
        }
        .table1 td {
            padding: 5px;
            font-size: 14px;
        }
        
        body {
            font-size: 15px!important;
        }
        
        .nopadding_td td {
            padding: 0 !important;
            border: 0 none !important;
        }
        
        .table1 tbody td {
            border: 1px solid #000;
            height: 35px;
        }
        
        .noborder_top td {
            border-top: 0 none !important;
        }
        
        .noborder_right {
            border-right: 0 none !important;
        }
        
        .noborder_left {
            border-left: 0 none !important;
        }
        
        .noborder_bottom td {
            border-bottom: 0 none !important;
        }
        
        .textalign-left {
            text-align: left;
        }
        
        .choose {
            margin-right: 20px;
        }
        
        .choose_active {
            background: url(<%=basePath%>images/gou.png) no-repeat left center;
        }
        
        .choose em {
            margin-right: 5px;
            font-size: 20px;
        }
        
        em {
            font-style: normal;
        }

        td p{
            margin-top: 15px;
        }
        
         @media print {
            #printBtn1 {
                display: none
            }
        }
    </style>
  </head>
  
    <script>
        //婚姻状况
        var maritalStatusObj = null;

        var relativeObj = null;
        
        var isDivorceAgreement = ""; 
        var divorceType = "";
    
        $(function() {
            //婚姻情况
	        $.ajax({
	            type: "post",//使用post方法访问后台
	            dataType: "json",//返回json格式的数据
	            async:false,
	            url: "aa10Action_listAa10All",//要访问的后台地址
	            data:{"aa10.letter":"maritalStatus" ,"aa10.name":"婚姻情况" },
	            complete :function(){$("#load").hide();},//AJAX请求完成时隐藏loading提示
	            success: function(msg){//msg为返回的数据，在这里做数据绑定
	                if(msg.success){
	                    maritalStatusObj = msg.obj.rows;
	                }
	            }
	        });
            //家庭关系
	        $.ajax({
	            type: "post",//使用post方法访问后台
	            dataType: "json",//返回json格式的数据
	            async:false,
	            url: "aa10Action_listAa10All",//要访问的后台地址
	            data:{"aa10.letter":"homeRelative" ,"aa10.name":"家庭关系" },
	            complete :function(){$("#load").hide();},//AJAX请求完成时隐藏loading提示
	            success: function(msg){//msg为返回的数据，在这里做数据绑定
	                if(msg.success){
	                    relativeObj = msg.obj.rows;
	                }
	            }
	        });
            
            $.ajax({
	            type: "post",//使用post方法访问后台
	            dataType: "json",//返回json格式的数据
	            async:false,
	            url: "securityPersonApply2Action_findById",//要访问的后台地址
	            data:{"securityPersonApply.id":<%=securityPersonApplyId%>},
	            success: function(msg){//msg为返回的数据，在这里做数据绑定
	                if(msg.success){
	                	/*if(msg.obj.houseRegister != null && msg.obj.houseRegister.parent != null && msg.obj.houseRegister.parent.parent != null){
	                	    $("#houseRegister").text(msg.obj.houseRegister.parent.parent.name  + "-" + msg.obj.houseRegister.parent.name + "-" + msg.obj.houseRegister.name)
	                	}*/
	                	$("#name").text(msg.obj.securityPersonName);
	                	$("#idCard").text(msg.obj.securityPersonIdCard);
	                	gender = parseInt(msg.obj.securityPersonIdCard.substr(16, 1)%2);
					    if(gender == 1){
							$("#sex").text("男");
						}
						else{
							$("#sex").text("女");
						}
	                	$("#houseRegister").text(msg.obj.houseRegister.name+"-"+msg.obj.community);
	                	$("#company").text(msg.obj.company);
	                	$("#accountAddress").text(msg.obj.accountAddress);
	                	var maritalStatus = "";
	                	for(var nItem = 0; nItem < maritalStatusObj.length; nItem++ ){
			            	if(maritalStatusObj[nItem].code == msg.obj.maritalStatus){
			                	maritalStatus = maritalStatusObj[nItem].value;
			                }
			            }
	                	$("#maritalStatus").text(maritalStatus);
	                	$("#applyDepartmentCommunity").text(msg.obj.applyDepartmentName+"-"+msg.obj.applyDepartmentCommunity);
	                	var securityPersonId = msg.obj.securityPersonId;
	                	//配租房屋地址
	                	$.ajax({
			                type: "post",//使用post方法访问后台
			                dataType: "json",//返回json格式的数据
			                async:false,
			                url: "securityPersonHouseAction_listSecurityPersonHouse",//要访问的后台地址
			                data:{"securityPersonHouse.securityPerson.id":securityPersonId},
			                success: function(msg){//msg为返回的数据，在这里做数据绑定
			                    if(msg.success){
			                    	if(msg.obj.rows.length>0){
			                        	$("#houseAddress").text(msg.obj.rows[0].houseAddress);
			                    	}else{
			                    		$("#houseAddress").text("轮候")
			                    	}
			                    }
			                }
			            });
	                	$("#avgIncome").text(msg.obj.avgIncome);
	                	//现住房情况
	                	if(msg.obj.currentHouseSituation=="1"){
		                	$('.house_info span').eq(0).addClass('choose_active');
	                		$("#existReal").text(msg.obj.existReal);
	                		$("#existArea").val(msg.obj.existArea);
	                		$("#propertyPerson").val(msg.obj.propertyPerson);
	                	}
	                	if(msg.obj.isAssignmentHouse=="1"){
	                		$('.turn_info span').eq(0).addClass('choose_active');
	                		$("#isAssignmentHouseArea").val(msg.obj.isAssignmentHouseArea);
	                	}else if(msg.obj.isAssignmentHouse=="2"){
	                		$('.turn_info span').eq(1).addClass('choose_active');
	                	}
	                	$.ajax({
				            type: "post",//使用get方法访问后台
				            dataType: "json",//返回json格式的数据
				            async:false,
				            url: "securityPersonApply2Action_listSecurityPersonApplyRelative",//要访问的后台地址
				            data: "securityPersonApplyId="+<%=securityPersonApplyId%>,//要发送的数据
				            complete :function(){$("#load").hide();},//AJAX请求完成时隐藏loading提示
				            success: function(msg){//msg为返回的数据，在这里做数据绑定
				                var data = msg.obj.rows;
				                var isSubsistenceAllowancesNum = 0;
				                var bankTotalAll = 0;
				                var securitiesTotalAll = 0;
				                var commercialInsuranceAll = 0;
				                var carList = new Array();
				                var businessList = new Array();
				                for(var i = 0; i < data.length; i++){
				                	console.log(data)
				                	if(data[i].relative=="0"){
				                		$("#residenceNo").text(data[i].residenceNo);
				                		isDivorceAgreement = data[i].isDivorceAgreement; 
                                        divorceType = data[i].divorceType;
				                	}
				            	    $("#name"+i).text(data[i].name);
				            	    var relative = "";
							        for(var nItem = 0; nItem < relativeObj.length; nItem++ ){
							            if(relativeObj[nItem].code == data[i].relative){
							                relative = relativeObj[nItem].value;
							            }
							        }
				            	    $("#relative"+i).text(relative);
				            	    $("#idCard"+i).text(data[i].idCard);
				            	    var maritalStatus = "";
			                        for(var nItem = 0; nItem < maritalStatusObj.length; nItem++ ){
			                            if(maritalStatusObj[nItem].code == data[i].maritalStatus){
			                               maritalStatus = maritalStatusObj[nItem].value;
			                            }
			                        }
			                        $("#maritalStatus"+i).text(maritalStatus);
			                        $("#isUrban"+i).text(data[i].isUrban==1?"是":"否")
			                        
			                        var incomeAll = 0;
			                        var wageIncome = (data[i].wageIncome ==undefined) ? 0:data[i].wageIncome;
			                        var operatingNetIncome = (data[i].operatingNetIncome ==undefined) ? 0:data[i].operatingNetIncome;
			                        var propertyIncome = (data[i].propertyIncome ==undefined) ? 0:data[i].propertyIncome;
			                        var otherIncome = (data[i].otherIncome ==undefined) ? 0:data[i].otherIncome;
			                        incomeAll = wageIncome+operatingNetIncome+propertyIncome+otherIncome;
			                        $("#incomeAll"+i).text(incomeAll);
									var bankTotal = (data[i].bankTotal ==undefined) ? 0:data[i].bankTotal;
									var securitiesTotal = (data[i].securitiesTotal ==undefined) ? 0:data[i].securitiesTotal;
									var commercialInsurance = (data[i].commercialInsurance ==undefined) ? 0:data[i].commercialInsurance;
			                        bankTotalAll+=bankTotal;
			                        securitiesTotalAll+=securitiesTotal;
			                        commercialInsuranceAll+=commercialInsurance;
			                        
			                        var isSubsistenceAllowances =""
			                        if(data[i].isSubsistenceAllowances =="1"){
			                        	isSubsistenceAllowances = "是";
			                        	isSubsistenceAllowancesNum++;
			                        }else if(data[i].isSubsistenceAllowances =="2"){
			                        	isSubsistenceAllowances = "否";
			                        }
			                        $("#isSubsistenceAllowances"+i).text(isSubsistenceAllowances);
			                        
			                        $.ajax({
				                        type: "post",//使用get方法访问后台
				                        dataType: "json",//返回json格式的数据
				                        async:false,
				                        url: "securityPersonApply2Action_findCarByRelativeId",//要访问的后台地址
				                        data: "relativeId="+data[i].id,//要发送的数据
				                        complete :function(){$("#load").hide();},//AJAX请求完成时隐藏loading提示
				                        success: function(msg){
					                        //车辆信息
					                        if(msg.obj[0]!=null&&msg.obj[0]!=''){
					                            carList.push(msg.obj[0]);
					                        }
					                        //工商信息
                                            if(msg.obj[1]!=null&&msg.obj[1]!=''){
					                            businessList.push(msg.obj[1]);
                                            }
					                    }
				                    });
				                }
				                if(carList!=null&&carList!=''){
                                    $('.car_info span').eq(1).addClass('choose_active');
                                    var car = carList[0];
                                    $("#carOwner").val(car[0].applyRelativeName);
                                    $("#vehicleBrand").val(car[0].vehicleBrand);
                                    $("#vehicleModel").val(car[0].vehicleModel);
                                    $("#buyFirstTime").val(dealDate(car[0].buyFirstTime));
                                    $("#estimatePrice").val(car[0].estimatePrice);
                                }else{
                                    $('.car_info span').eq(0).addClass('choose_active');
                                }
				                if(businessList!=null&&businessList!=''){
                                    $('.buss_info span').eq(1).addClass('choose_active');
                                    var business = businessList[0];
                                    $("#businessName").val(business[0].businessName);
                                    $("#businessOwner").val(business[0].shareholderName);
                                    
                                }else{
                                    $('.buss_info span').eq(0).addClass('choose_active');
                                }
				                $("#bankTotal").val(bankTotalAll);
				                $("#securitiesTotal").val(securitiesTotalAll);
				                $("#commercialInsurance").val(commercialInsuranceAll);
				                $("#isSubsistenceAllowancesNum").text(isSubsistenceAllowancesNum);
				            }
				        })
                        if(isDivorceAgreement=="1"){
                            $('.divorceInfo span').eq(0).addClass('choose_active');
                        }else if(isDivorceAgreement=="2"){
                            $('.divorceInfo span').eq(1).addClass('choose_active');
                            if(divorceType=="1"){
                                $('.divorceInfo span').eq(2).addClass('choose_active');
                            }else if(divorceType=="2"){
                                $('.divorceInfo span').eq(3).addClass('choose_active');
                            }
                        }
	                }
	            }
	        });
            //打印按钮
	        $('#printBtn1').click(function() {
                window.print();
            })
        })
    </script>
   <body>
      <input type="button" value="打印申请表" id="printBtn1" style="width: 100px;position: absolute;left: 10;top: 10;">
      <div id="content">
      <table class="table1" style="width: 792px;border-collapse: collapse;margin: 0 auto;text-align: center;border-right:1px solid #000;table-layout: fixed;">
        <caption style="font-size: 26px;font-weight: bold!important;padding:8px 0;font-family: '黑体';">淮安市市区公租房实物配租复核申请表（城镇住房困难家庭）</caption>
        <thead>
	        <tr class="nopadding_td">
	            <td width="30" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="80" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="70" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="100" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="60" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="120" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="40" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="80" style="height: 0;border: 0;padding: 0;"></td>
	            <td width="80"></td>
	            <td style="height: 0;border: 0;padding: 0;"></td>
	        </tr>
        </thead>
        <tbody>
        <tr>
            <td colspan="2">申请人姓名</td>
            <td colspan="2"><span id="name"></span></td>
            <td>性别</td>
            <td><span id="sex"></span></td>
            <td colspan="2">身份证号</td>
            <td colspan="2"><span id="idCard"></span></td>
        </tr>
        <tr>
            <td colspan="2">工作单位</td>
            <td colspan="4"><span id="company"></span></td>
            <td colspan="2">婚姻状况</td>
            <td colspan="2"><span id="maritalStatus"></span></td>
        </tr>
        <tr>
            <td colspan="2">申请所在地</td>
            <td colspan="4"><span id="applyDepartmentCommunity"></span></td>
            <td colspan="2">配租房地址</td>
            <td colspan="2"><span id="houseAddress"></span></td>
        </tr>
        <tr>
            <td colspan="2">户籍所在地</td>
            <td colspan="4"><span id="houseRegister"></span></td>
            <td colspan="2">户籍号</td>
            <td colspan="2"><span id="residenceNo"></span></td>
        </tr>
        <tr>
            <td colspan="2">户口本住址</td>
            <td colspan="4"><span id="accountAddress"></span></td>
            <td colspan="2">家庭人均月收入</td>
            <td colspan="2"><span id="avgIncome"></span></td>
        </tr>
        <tr>
            <td>共同申请人信息</td>
            <td colspan="9" style="padding: 0;">
                <table style="width:100%;border-collapse: collapse;border-top:0 none;border-bottom:0 none;table-layout: fixed;">
                    <tr class="nopadding_td">
                        <th width="79" style="height: 0;border: 0;padding: 0;"></th>
                        <th width="70" style="height: 0;border: 0;padding: 0;"></th>
                        <th width="100" style="height: 0;border: 0;padding: 0;"></th>
                        <th width="60" style="height: 0;border: 0;padding: 0;"></th>
                        <th width="120" style="height: 0;border: 0;padding: 0;"></th>
                        <th width="40" style="height: 0;border: 0;padding: 0;"></th>
                        <th width="80" style="height: 0;border: 0;padding: 0;"></th>
                        <th width="80"></th>
                        <th style="height: 0;border: 0;padding: 0;"></th>
                    </tr>
                    <tr class="noborder_top">
                        <td class="noborder_left">姓名</td>
                        <td>与户主<br/>关系</td>
                        <td colspan="2">身份证号码</td>
                        <td colspan="2">婚姻状况（已婚、<br/>离异、丧偶、单身）</td>
                        <td>月收入<br/>（元）</td>
                        <td>是否享受<br/>低保</td>
                        <td class="noborder_right">持城市居民户口是否满2年以上</td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name0"></span></td>
                        <td><span id="relative0"></span></td>
                        <td colspan="2"><span id="idCard0"></span></td>
                        <td colspan="2"><span id="maritalStatus0"></span></td>
                        <td><span id="incomeAll0"></span></td>
                        <td><span id="isSubsistenceAllowances0"></span></td>
                        <td class="noborder_right"><span id="isUrban0"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name1"></span></td>
                        <td><span id="relative1"></span></td>
                        <td colspan="2"><span id="idCard1"></span></td>
                        <td colspan="2"><span id="maritalStatus1"></span></td>
                        <td><span id="incomeAll1"></span></td>
                        <td><span id="isSubsistenceAllowances1"></span></td>
                        <td class="noborder_right"><span id="isUrban1"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name2"></span></td>
                        <td><span id="relative2"></span></td>
                        <td colspan="2"><span id="idCard2"></span></td>
                        <td colspan="2"><span id="maritalStatus2"></span></td>
                        <td><span id="incomeAll2"></span></td>
                        <td><span id="isSubsistenceAllowances2"></span></td>
                        <td class="noborder_right"><span id="isUrban2"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name3"></span></td>
                        <td><span id="relative3"></span></td>
                        <td colspan="2"><span id="idCard3"></span></td>
                        <td colspan="2"><span id="maritalStatus3"></span></td>
                        <td><span id="incomeAll3"></span></td>
                        <td><span id="isSubsistenceAllowances3"></span></td>
                        <td class="noborder_right"><span id="isUrban3"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name4"></span></td>
                        <td><span id="relative4"></span></td>
                        <td colspan="2"><span id="idCard4"></span></td>
                        <td colspan="2"><span id="maritalStatus4"></span></td>
                        <td><span id="incomeAll4"></span></td>
                        <td><span id="isSubsistenceAllowances4"></span></td>
                        <td class="noborder_right"><span id="isUrban4"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name5"></span></td>
                        <td><span id="relative5"></span></td>
                        <td colspan="2"><span id="idCard5"></span></td>
                        <td colspan="2"><span id="maritalStatus5"></span></td>
                        <td><span id="incomeAll5"></span></td>
                        <td><span id="isSubsistenceAllowances5"></span></td>
                        <td class="noborder_right"><span id="isUrban5"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name6"></span></td>
                        <td><span id="relative6"></span></td>
                        <td colspan="2"><span id="idCard6"></span></td>
                        <td colspan="2"><span id="maritalStatus6"></span></td>
                        <td><span id="incomeAll6"></span></td>
                        <td><span id="isSubsistenceAllowances6"></span></td>
                        <td class="noborder_right"><span id="isUrban6"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name7"></span></td>
                        <td><span id="relative7"></span></td>
                        <td colspan="2"><span id="idCard7"></span></td>
                        <td colspan="2"><span id="maritalStatus7"></span></td>
                        <td><span id="incomeAll7"></span></td>
                        <td><span id="isSubsistenceAllowances7"></span></td>
                        <td class="noborder_right"><span id="isUrban7"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left"><span id="name8"></span></td>
                        <td><span id="relative8"></span></td>
                        <td colspan="2"><span id="idCard8"></span></td>
                        <td colspan="2"><span id="maritalStatus8"></span></td>
                        <td><span id="incomeAll8"></span></td>
                        <td><span id="isSubsistenceAllowances8"></span></td>
                        <td class="noborder_right"><span id="isUrban8"></span></td>
                    </tr>
                    <tr>
                        <td class="noborder_left" colspan="2">家庭人均月收入</td>
                        <td colspan="2"><span id="avgIncome"></span><span style="float:right;">元/月·人</span></td>
                        <td>离婚协议</td>
                        <td colspan="4" class="divorceInfo"><span class="choose"><em>□</em>无</span>  <span class="choose"><em>□</em>有</span>(<span class="choose"><em>□</em>法院判决</span><span class="choose"><em>□</em>民政)</span></td>
                    </tr>
                </table>
            </td>
        </tr>
        <tr>
            <td rowspan="5">家庭相关信息</td>
            <td rowspan="2" style="white-space:nowrap;">现住房情况</td>
            <td colspan="8" class="textalign-left house_info">
                <div>
                    <span class="choose"><em>□</em>自有房产</span>
                    房屋坐落：<span class="setunderline" id="existReal"></span> ，面积： <input readonly="readonly" id="existArea" type="text" style="width:50px;border:0 none;border-bottom:1px solid #000;" > 平方米，产权人：<input readonly="readonly" id="propertyPerson" type="text" style="width:100px;border:0 none;border-bottom:1px solid #000;">
                </div> 
            </td>
        </tr>
        <tr>
            <td colspan="8" class="textalign-left turn_info">是否存在转让房产、取得拆迁安置补偿不满两年的情况：&nbsp;&nbsp;<span class="choose"><em>□</em>是</span>    <span class="choose"><em>□</em>否</span></td>
        </tr>
        <tr>
            <td>机动车信息</td>
            <td colspan="8" class="textalign-left car_info" style="white-space: nowrap;font-size:15px;">
            <span class="choose"><em>□</em>无 </span>
            <span class="choose"><em>□</em>有</span> 车主：<input readonly="readonly" id="carOwner" type="text" style="width:90px;border:0 none;border-bottom:1px solid #000;">，车辆品牌：<input readonly="readonly" id="vehicleBrand" type="text" style="width:110px;border:0 none;border-bottom:1px solid #000;"> 
                                                                ，车辆型号：<input readonly="readonly" id="vehicleModel" type="text" style="width:120px;border:0 none;border-bottom:1px solid #000;">
            <br/> 购置日期：<input readonly="readonly" id="buyFirstTime" type="text" style="width:90px;border:0 none;border-bottom:1px solid #000;">，车辆价值：<input readonly="readonly" id="estimatePrice" type="text" style="width:100px;border:0 none;border-bottom:1px solid #000;"> （车辆按申请时有效车辆保险单记载价值）</td>
        </tr>
        <tr>
            <td style="white-space:nowrap;">工商信息</td>
            <td colspan="8" class="textalign-left buss_info">
                是否持有企业股份 <span class="choose"><em>□</em>无</span> <span class="choose"><em>□</em>有</span> 企业名称：</span><input readonly="readonly" id="businessName" type="text" style="width:180px;border:0 none;border-bottom:1px solid #000;"> 持股人：<input readonly="readonly" id="businessOwner" type="text" style="width:100px;border:0 none;border-bottom:1px solid #000;"> </td>
        </tr>
        <tr>
            <td style="white-space:nowrap;">金融信息</td>
            <td colspan="8" class="textalign-left" style="white-space: nowrap;">证券：<input readonly="readonly" id="securitiesTotal" type="text" style="width:100px;border:0 none;border-bottom:1px solid #000;">元，银行存款：<input readonly="readonly" id="bankTotal" type="text" style="width:100px;border:0 none;border-bottom:1px solid #000;">元， 商业保险：<input readonly="readonly" id="commercialInsurance" type="text" style="width:100px;border:0 none;border-bottom:1px solid #000;">元 </td>
        </tr>
        <tr>
            <td colspan="10" style="text-align:left;text-indent: 30px;letter-spacing: 2px;">
                <p>以上填写的所有信息及提供的资料真实无误，无隐瞒。并同意相关部门和单位审查申请人和共同申请人经济、财产状况等情况，并严格遵守淮安市保障性住房相关规定。如有不诚信申报行为或不实，本人及家庭承诺在相关规定的禁止申请期限内不再申请保障性住房。</p>
                <img src="<%=basePath%>images/commitment2.jpg" alt="">
                <div style="float:right;margin: 20px 160px 20px 0;">
                    <p>申请人（签字）：</p> 

                    <p>共同申请人（签字）：</p> 

                    <p>&emsp;&emsp;年&emsp;&emsp;月&emsp;&emsp;日</p> 

                </div>
            </td>
        </tr>
        </tbody>
    </table>
    </div>
  </body>
</html>