New Version 4.

0
User Request Form /IT/VII/2018
User Information
Name Request date:
Title
Dept/Div
Telp / Ext Region/ Location : Floor :
Email
Request Type (*)
Create Billing System Role:
Delete CRM Role:
Change Ticketing System CCR: Service Team:
Install Cisco Call Center Team Name: Inbound Outbound
Other Local SLJJ Cellular International
CIPC CAD CSD Mediasense IVR
Broadcast SMS Email TVMS
VPN Access / Duration:
IPTV (**) IPTV IQAS IPTV SLCS
IPTV Statistic IPTV Envivio NMS
Network Element (**) NE Corporate NE Retail
Full Access View Only
NMS Netnumen Cacti Retail Cacti Corp.
WUG U2000
Pin Telp (**)
Line Telp (**) New Relocation
Software / Application Name
User Login Active Directory
Folder Sharing / Name (***)
Access Type Modify
Read Only
Email mncplaymedia.com Account Name
Other:

Purpose / Project Name

(*) Centang pilihan

(**) Form ini ditanda tangani oleh Departement In Charge
(***) Folder Sharing hanya bersifat sementara, dimohon user tetap memiliki BACKUP
Approved by Acknowledged by

Requestor Div Head BOS Section Head BOS Dept Head

BOS Notes
Executed by

Person In Charge **Dept In Charge