FORM INFORMATION TECHNOLOGY REQUEST

Requestor Fitriani Wilujeng Septyandini Request Date 13-Nov-18

Div / Dept Project & Implementation
/ ProjectDirectorate
SACME Jatim Regional Name Jatim
Position Regional Project Support EIN (NIK) 555512140373
Email Address fitriani.septyandini@tower-bersama.com User ID 555512140373
Attachment [ ] By Excel [X] By Email [ ] No Attachment
Request Purpose Open akses menu "Project" modul "Project Activity Site" dan "Dashboard Collection"

For External Request PIC Name

Company Name Email Address

Check requested service(s) Fill request detail

[ ] Email
[ ] New [ ] Non Active [ ] Reactivate [ ] Reset Password
[ ] Domain Access
For Email: [ ] Internal [ ] External [ ] Add Quota: _______ mb .
[ ] Internet Access
[ ] VPN Access [ ] New [ ] Non Active [ ] Additional [ ] Renewal
[ ] Install Software Software Name : [ ] New[ ] Reinstall
[ ] Folder Sharing Folder Name : _______________________ [ ] New[ ] Active/ Non-Active

[X] Application [ X ] TBGSys [ ] Dynamic AX [ ] Vendor Portal [ ] Dashboard [ ] MSS

Access [ ] HRIS [ ] My TBIG [ ] Other: _________________ .
[ ] New [ ] Non Active [ ] Reactivate [ ] Reset Password
[ ] Change Menu Matrix: ______________________ (need attachment) .
[ ] Data Request
[ ] Update Data (insert, delete, update) [ ] Adhoc Report/ Data

Request Reason: O
(need supporting attachment) Filled by IT: [ ] Need CR

User Approval IT Approval

IT Service/
Requestor User Dept Head User Div Head IT Division Head PIC Execution
Infra Head

Date: 13 Nov 18 Date: 13 Nov 18 Date: Date: Date: Date:

Fitriani Wilujeng Aji Bagus W Name: Name: Name: Name:

** filled with X sign ver. 201211