Information Technology Department Doc No: ITD-F01 Issue No.

5
Title: IT Equipments / Facilities Form Issue Date: 01-May-2015 Page 1 of 1

First Name: Home Telephone No.

Last Name: Mobile No.:
Father's Name: Designation:
Office (Location): Department:
IP Extension No.: HOD Name:

EMAIL ACTIVATION To be filled by IT: Group: Normal Standard Advance

Activation Date: Created by:
Internal External Home Directory: Authorized By:
Email address: Date:

INTERNET ACCESS To be filled by IT: Group: Normal Exclusive Timing

Purpose of Use: Created by:
Yes No Authorized By:
Date:

IP TELEPHONE
Direct Dialing IP Phone Soft Phone
Yes No Extension

PC / LAPTOP Purpose of Use / Justifiction:

PC Laptop Delivery Date: Authorized by:

Date:

PRINTER / SCANNER Purpose of Use / Justifiction:

Printer Scanner Specification: Authorized by:

Delivery Date: Date:

HR / HOD'S APPROVAL

Yes No Name Signature

I.T HEAD APPROVAL

Yes No Name Signature

EXECUTIVE DIRECTOR'S
APPROVAL

Yes No Name Signature