<HTML><HEAD><TITLE>同意書</TITLE>
<META http-equiv=Content-Type content="text/html; charset=big5">
<STYLE fprolloverstyle>UNKNOWN {
	TEXT-DECORATION: none
}
</STYLE>

<SCRIPT language=JavaScript>
<!--
function MM_timelinePlay(tmLnName, myID) { //v1.2
  //Copyright 1997 Macromedia, Inc. All rights reserved.
  var i,j,tmLn,props,keyFrm,sprite,numKeyFr,firstKeyFr,propNum,theObj,firstTime=false;
  if (document.MM_Time == null) MM_initTimelines(); //if *very* 1st time
  tmLn = document.MM_Time[tmLnName];
  if (myID == null) { myID = ++tmLn.ID; firstTime=true;}//if new call, incr ID
  if (myID == tmLn.ID) { //if Im newest
    setTimeout('MM_timelinePlay("'+tmLnName+'",'+myID+')',tmLn.delay);
    fNew = ++tmLn.curFrame;
    for (i=0; i<tmLn.length; i++) {
      sprite = tmLn[i];
      if (sprite.charAt(0) == 's') {
        if (sprite.obj) {
          numKeyFr = sprite.keyFrames.length; firstKeyFr = sprite.keyFrames[0];
          if (fNew >= firstKeyFr && fNew <= sprite.keyFrames[numKeyFr-1]) {//in range
            keyFrm=1;
            for (j=0; j<sprite.values.length; j++) {
              props = sprite.values[j]; 
              if (numKeyFr != props.length) {
                if (props.prop2 == null) sprite.obj[props.prop] = props[fNew-firstKeyFr];
                else        sprite.obj[props.prop2][props.prop] = props[fNew-firstKeyFr];
              } else {
                while (keyFrm<numKeyFr && fNew>=sprite.keyFrames[keyFrm]) keyFrm++;
                if (firstTime || fNew==sprite.keyFrames[keyFrm-1]) {
                  if (props.prop2 == null) sprite.obj[props.prop] = props[keyFrm-1];
                  else        sprite.obj[props.prop2][props.prop] = props[keyFrm-1];
        } } } } }
      } else if (sprite.charAt(0)=='b' && fNew == sprite.frame) eval(sprite.value);
      if (fNew > tmLn.lastFrame) tmLn.ID = 0;
  } }
}

function MM_initTimelines() {
    //MM_initTimelines() Copyright 1997 Macromedia, Inc. All rights reserved.
    var ns = navigator.appName == "Netscape";
    document.MM_Time = new Array(1);
    document.MM_Time[0] = new Array(2);
    document.MM_Time["Timeline1"] = document.MM_Time[0];
    document.MM_Time[0].MM_Name = "Timeline1";
    document.MM_Time[0].fps = 15;
    document.MM_Time[0][0] = new String("sprite");
    document.MM_Time[0][0].slot = 1;
    if (ns)
        document.MM_Time[0][0].obj = document["Layer1"];
    else
        document.MM_Time[0][0].obj = document.all ? document.all["Layer1"] : null;
    document.MM_Time[0][0].keyFrames = new Array(1, 25);
    document.MM_Time[0][0].values = new Array(3);
    document.MM_Time[0][0].values[0] = new Array(17,39,61,84,106,128,150,172,195,217,239,261,284,306,328,350,372,395,417,439,461,483,506,528,550);
    document.MM_Time[0][0].values[0].prop = "left";
    document.MM_Time[0][0].values[1] = new Array(402,401,400,400,399,398,397,396,396,395,394,393,393,392,391,390,389,389,388,387,386,385,385,384,383);
    document.MM_Time[0][0].values[1].prop = "top";
    if (!ns) {
        document.MM_Time[0][0].values[0].prop2 = "style";
        document.MM_Time[0][0].values[1].prop2 = "style";
    }
    document.MM_Time[0][0].values[2] = new Array("inherit","inherit");
    document.MM_Time[0][0].values[2].prop = "visibility";
    if (!ns)
        document.MM_Time[0][0].values[2].prop2 = "style";
    document.MM_Time[0][1] = new String("sprite");
    document.MM_Time[0][1].slot = 2;
    if (ns)
        document.MM_Time[0][1].obj = document["Layer1"];
    else
        document.MM_Time[0][1].obj = document.all ? document.all["Layer1"] : null;
    document.MM_Time[0][1].keyFrames = new Array(26, 50);
    document.MM_Time[0][1].values = new Array(3);
    document.MM_Time[0][1].values[0] = new Array(546,549,551,554,556,559,562,564,567,569,572,574,577,580,582,585,587,590,593,595,598,600,603,605,608);
    document.MM_Time[0][1].values[0].prop = "left";
    document.MM_Time[0][1].values[1] = new Array(387,378,370,361,352,343,335,326,317,308,300,291,282,273,265,256,247,238,229,221,212,203,195,186,177);
    document.MM_Time[0][1].values[1].prop = "top";
    if (!ns) {
        document.MM_Time[0][1].values[0].prop2 = "style";
        document.MM_Time[0][1].values[1].prop2 = "style";
    }
    document.MM_Time[0][1].values[2] = new Array("inherit","inherit");
    document.MM_Time[0][1].values[2].prop = "visibility";
    if (!ns)
        document.MM_Time[0][1].values[2].prop2 = "style";
    document.MM_Time[0].lastFrame = 50;
    for (i=0; i<document.MM_Time.length; i++) {
        document.MM_Time[i].ID = null;
        document.MM_Time[i].curFrame = 0;
        document.MM_Time[i].delay = 1000/document.MM_Time[i].fps;
    }
}
//-->
</SCRIPT>

<META content="MSHTML 5.50.4134.600" name=GENERATOR></HEAD>
<BODY vLink=#006633 bgColor=#ffffff>
<DIV align=center>
<TABLE cellSpacing=0 cellPadding=0 width=700 border=0>
  <TBODY>
  <TR>
    <TD colSpan=3>
      <DIV align=center><FONT color=#3300cc size=5><B><FONT 
      color=#0033cc>同　　意　　書</FONT></B></FONT><FONT color=#0033cc><B> 
      </B><B></B></FONT></DIV></TD></TR>
  <TR>
    <TD width=30 height=284>
      <P>&nbsp;</P></TD>
    <TD width=647 height=284>
      <P><FONT 
      size=3>立切結書人　　　　　　　確實為無一定雇主（無僱傭他人，也無被他人僱傭）之從事病患家事服務等工作之勞工，並依照無一定雇主之會員而參加本工會所辦勞工保險、全民健康保險由貴會為投保單位加入勞工保險及全民健康保險，並遵照貴會各項規定按期繳納會費及勞保費、健保費。如預期不繳清者願意負滯納金一倍以上，三倍以下之罰緩，若發生各款項或積欠時，本人願意由貴會向勞保局或健保局退保手續，或隱瞞致使發生勞保局拒付勞工保險現金給付者，一切後果由本人負責，恐口無憑特立此切結書為憑。</FONT></P>
      <P><FONT size=3>此　　　　　　　致</FONT></P>
      <P><FONT size=3>新北市病患家事服務職業工會　　　台照 立切結書人：　　　　　　蓋章</FONT></P>
      <P><FONT size=3>住　　　址：</FONT></P>
      <P><FONT size=3>身分證字號： 　　　　　　　　　　　　　</FONT><FONT size=3>中　華　民　國　　年　　月　　日 
      </FONT></P></TD>
    <TD width=23 height=284>&nbsp;</TD></TR>
  <TR>
    <TD colSpan=3 height=31>
      <DIV align=left>
      <DIV align=left><FONT color=#0033cc size=2><BR>※</FONT><FONT color=#ff66cc 
      size=2><FONT color=#ff3300>請將本頁資料列印出來填寫好後</FONT><FONT 
      color=#0033cc>，請攜帶健保轉出單、戶口名簿、 </FONT></FONT><FONT color=#0033cc 
      size=2>身分證影印本、 印章及 照片兩張親自向工會辦理謝謝 </FONT></DIV></DIV></TD></TR>

<script type="text/javascript">
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www.");
document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E"));
</script>
<script type="text/javascript">
var pageTracker = _gat._getTracker("UA-5490399-2");
pageTracker._trackPageview();
</script>

</BODY></HTML>