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["延期缴费申请表"]
["申请日期","2022年    月    日"]
["总户号"]
["户  名"]
["用水地址"]
["经办人",null,"手机"]
["身份证号码",null,null,"统一社会信用代码"]
["情况说明"]
[null,"   本公司因受疫情影响，特向贵单位申请  月--  月水费延期缴纳，并免除相关滞纳金。本公司承诺，将在延期缴费政策结束后，足额缴纳水费。如未按时缴纳，愿意承担拖欠水费造成的相关违约责任。"]
[null,"申请单位（人）"]
[null," （签章）"]