User Access Management Form
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 *
Designation *
Department /Section
*
Location / OU *
Contact Number (* Extn. /
Mobile)
Extn :
Mobile No :
Reporting to (User Name) *
SECTION B: Request Type
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Internet *
Yes
No
Distribution List
Yes
No
User Name *
Mail ID *
HIS ID *
AD Login *
Share Folder *
If Yes, please click an option
Create
Delete
Modify
If Yes, please click an option
Create
Delete
Modify
If Yes, please click an option
Create
Delete
Modify
If Yes, please click an option
Create
Delete
Modify
If Yes, please click an option
Create
Delete
Modify
If Yes, please click an option
Create
Delete
Modify
Other Access Requirement:
USB/CD/Camera/ etc..
Remarks
SECTION C: Approvals
Endorsed By *
Signature/ Date/
Comments *
Approved By *
Signature/
Date/
Comments *
Verification
Designation *
(Local 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
Copyright © EHG IT - 2019. This document is the property of EHG IT. All rights reserved