ADS/Outlook/Lync Profile

A. Request

New ADS Profile New Outlook Profile New Skype Account

Terminate ADS Profile Terminate Outlook Prof Terminate Skype Account

Note: *) wajib diisi
B. User Details
*First Name : Bagus Dwi
*Last Name : Permana
Middle Initial :
DS ID :
* Location/City : Jakarta, Indonesia
* Phone Number : +6281216874606
* Department : AEI
* Title : AEI Engineer
*Division/Business Unit : CTP

*Type : Personal/Shared/Process

* Supervisor’s Name : AMRUL ADAM

* Primary Identity Owner (PIO) :
* Secondary Identity Owner :
(SIO)
PDL/UDG requested :
Phone/Fax-Extension :
MS Office Standard Professional
PC/Notebook/Thin Client :
Printer connection :
*Billing Code/Cost center 6402 (Should be filled)
Create id same as (clone) :

*Signature Date requested

Dec 18th, 2018

*Manager Approval Date Approved

C. IT use only
Completed by Date