▌자막방송수신기 무료 보급 신청서

1. 인적사항   <TABLE style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; BORDER-COLLAPSE: collapse; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid"> <TBODY> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 1.7pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 88.08pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 1.7pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 성 명</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 197.18pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 1.7pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=2>   </TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 75.28pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 1.7pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 성 별</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 117.43pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 1.7pt solid; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center> ☐ 남 ☐ 여 </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 1.7pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 88.08pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 주민번호 앞자리</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 197.18pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=2> </TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 75.28pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 장애급수</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 117.43pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center>   </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 1.7pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 88.08pt; PADDING-RIGHT: 5.1pt; HEIGHT: 54.51pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center rowSpan=3> 연 락 처</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 73.77pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.17pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 보호자</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 316.12pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.17pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=3>   </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 73.77pt; PADDING-RIGHT: 5.1pt; HEIGHT: 36.34pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center rowSpan=2> 본 인</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt dotted; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 316.12pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.17pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=3>   </TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 316.12pt; PADDING-RIGHT: 5.1pt; HEIGHT: 18.17pt; BORDER-TOP: #000000 0.28pt dotted; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=3> ☐ 문자 ☐ 통화</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 1.7pt solid; BORDER-LEFT: #000000 1.7pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 88.08pt; PADDING-RIGHT: 5.1pt; HEIGHT: 38.3pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center rowSpan=2> 주 소</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt dotted; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 389.89pt; PADDING-RIGHT: 5.1pt; HEIGHT: 19.15pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=4> (현 거주지)</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 1.7pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 389.89pt; PADDING-RIGHT: 5.1pt; HEIGHT: 19.15pt; BORDER-TOP: #000000 0.28pt dotted; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center colSpan=4> (배송주소)</TD></TR></TBODY></TABLE>         2. 첨부서류 ✓첨부서류 미제출 시 접수되지 않습니다.   <TABLE style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; BORDER-COLLAPSE: collapse; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid"> <TBODY> <TR> <TD style="BORDER-BOTTOM: #000000 1.7pt solid; BORDER-LEFT: #000000 1.7pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 478.97pt; PADDING-RIGHT: 5.1pt; HEIGHT: 53.31pt; BORDER-TOP: #000000 1.7pt solid; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center> 가. 장애인복지카드 사본 또는 장애인등록증(필수) 나. 기초생활수급자 및 차상위계층 등 저소득층 증명서(해당자에 한함) ※ 저소득층 청각장애인은 우선적으로 보급 받으실 수 있습니다.</TD></TR></TBODY></TABLE>   ※ 저소득층 : 기초생활수급권자, 차상위계층[자활근로·본인부담경감·장애(아동)수당·장애연금(부가급여)·   한부모 가족]에 한함   3. 보급제품     <TABLE style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; BORDER-COLLAPSE: collapse; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid"> <TBODY> <TR> <TD style="BORDER-BOTTOM: #000000 1.7pt solid; BORDER-LEFT: #000000 1.7pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 478.97pt; PADDING-RIGHT: 5.1pt; HEIGHT: 42.09pt; BORDER-TOP: #000000 1.7pt solid; BORDER-RIGHT: #000000 1.7pt solid; PADDING-TOP: 1.41pt" vAlign=center> <TABLE style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; BORDER-COLLAPSE: collapse; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid"> <TBODY> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 92.88pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #d6d6d6; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 구분</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 367.39pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #d6d6d6; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 자막방송수신기</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 92.88pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #d6d6d6; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 규격</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 367.39pt; PADDING-RIGHT: 5.1pt; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 22“형 LED TV</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 92.88pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #d6d6d6; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 기능</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 367.39pt; PADDING-RIGHT: 5.1pt; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 자막 색상․크기․위치 변경 가능</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 92.88pt; PADDING-RIGHT: 5.1pt; BACKGROUND: #d6d6d6; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 기타</TD> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 1.41pt; PADDING-LEFT: 5.1pt; WIDTH: 367.39pt; PADDING-RIGHT: 5.1pt; HEIGHT: 20.48pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 1.41pt" vAlign=center> 디지털 방송수신 가능, 원클릭(One Click) 리모컨 제공</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>   2012 년 월 일 신청자 : (서명 또는 날인)   4. 개인정보 활용 동의     <TABLE style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; BORDER-COLLAPSE: collapse; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid"> <TBODY> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 5.66pt; PADDING-LEFT: 5.66pt; WIDTH: 476.24pt; PADDING-RIGHT: 5.66pt; HEIGHT: 75.78pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 5.66pt" vAlign=center> 본인은 청각장애인을 위한 방송수신기 무료 보급 사업을 지원받기 위하여 개인정보 일부(성명, 주민번호 앞자리, 연락처 등)를 제공하여, 보급 가능여부 심사에 활용되는 것을 동의합니다. 신청자 : (서명 또는 날인)</TD></TR> <TR> <TD style="BORDER-BOTTOM: #000000 0.28pt solid; BORDER-LEFT: #000000 0.28pt solid; PADDING-BOTTOM: 5.66pt; PADDING-LEFT: 5.66pt; WIDTH: 476.24pt; PADDING-RIGHT: 5.66pt; HEIGHT: 11.32pt; BORDER-TOP: #000000 0.28pt solid; BORDER-RIGHT: #000000 0.28pt solid; PADDING-TOP: 5.66pt" vAlign=center> ※ 신청인의 개인정보는 수신기 중복보급여부를 확인하기 위한 용도로만 사용되며, 제공된 정보는 ‘개인정보보호법’에 의거하여 소중하게 관리되며, 해당기관에서는 5년 간 보관 후 폐기함을 알려드립니다.</TD></TR></TBODY></TABLE> 한 국 방 송 통 신 전 파 진 흥 원 장 귀중                   <a href='javascript:fileFilterViewer("http://cfile295.uf.daum.net/attach/135A53474FAB2DDE1B191C", "/cfile295/13/5A53474FAB2DDE1B191C", "2012년_방송수신기_보급_사업_안내.hwp", "grpid%3D1BhS3%26fldid%3DKl2j%26dataid%3D259%26fileid%3D1%26regdt%3D20120510115529&url=http%3A%2F%2Fcfile295.uf.daum.net%2Fattach%2F135A53474FAB2DDE1B191C")'><img src="https://t1.daumcdn.net/daumtop_deco/icon/icon.hanmail.net/editor/p_hwp_s.gif?rv=1.0.1" border="0" alt="첨부파일" class="vam"/> 2012년_방송수신기_보급_사업_안내.hwp</a>