Team EHG IT
User Access Management
(Create ☐ / Modify ☐ / Delete ☐ / Password Reset)
*Mandatory fields for Creation/Deletion/Modifying the User Account
SECTION A : User Information
Employee Code *
First Name *
Middle Name
Last Name *
User Name *
Click here to enter text.
Designation *
Department /Section
*
Location / OU *
Contact Number (* Extn. / Mobile)
Reporting to (User Name) *
Click here to enter text.
Click here to enter text.
Extn :
Mobile No :
Click here to enter text.
SECTION B: Request Type
User Name *
☐ Yes
☐ No
Mail ID *
☐ Yes
☐ No
HIS ID *
☐ Yes
☐ No
AD Login *
☐ Yes
☐ No
Share Folder *
☐ Yes
☐ No
Internet *
☐ Yes
☐ No
Distribution List
☐ Yes
☐ No
If Yes, please click an option
☐ Create
☐ Delete
☐
If Yes, please click an option
☐ Create
☐ Delete
☐
If Yes, please click an option
☐ Create
☐ Delete
☐
If Yes, please click an option
☐ Create
☐ Delete
☐
If Yes, please click an option
☐ Create
☐ Delete
☐
If Yes, please click an option
☐ Create
☐ Delete
☐
Modify
Modify
Modify
Modify
Modify
Modify
Other Access Requirement:
Ex: USB Access
Remarks
SECTION C: Approvals
Endorsed By *
Approved By *
Signature/ Date/
Signature/ Date/
Comments *
Comments *
Verification (Local
Designation *
IT Head) *
Signature/ Date/
Comments *
VERIFY THE DETAILS ARE CORRECTLY PUT, IF THE DETAILS ARE NOT PUT, PLEASE RESEND BACK TO THE USER IMMEDIATELY, NO DATA SHOULD
BE BLANK, IF NOT REQUIRED, PLEASE PUT AS NOT APPLICABLE
Account (Created/ Deleted/ Modified)
Login Name for Active Directory
E-Mail-ID
Internal
Copyright © EHG IT - 2019. This document is the property of EHG IT - 2019. All rights reserved.