User Application Form M2000

V4.0 - Oct 2012

User Information : Name Personnel ID Company Email Address Position Region : : : : : : Mobile Phone : Department / Division :

User's Supervisor Information : Name Personnel ID Position Email Address : : : : Mobile Phone : Department / Division :

Account Information : OSS Module Type NE Name (M2000 IP Address) Account Permission Purpose Period Start Date : : : / / End Date : / / Viewer Performance Operation Configuration : : BSC RNC NodeB CORE

Terms and Conditions : 1.User must fill all information in User Application Form & agreed with the rules. 2.User will be responsible for the account. 3.Account will be active after get confirmation email from OSS Engineer. Signature Form Date User : : User Supervisor OSS Engineer Change Mgt.

Mumung Prihandoko OSS-IT MS HCPT TIFA Building 7th Floor Jl. Kuningan Barat No 26

Ashrul Sifa