PT.

STAR RUBBER (lambl Branch)

Page 1 of 1
EN.F0.01.001 fa220915 : IT Permission Form

Employee Code : !°fl Ooo •fl'\ Position ac.. D.litA

Full Name ~ c,r11c,ndo P.o f'?"c/,,.,c,/r.r Departmen,: : _,,:..::....:
(,lA _
User Name

Network Pelmlsfon Request New User O Change(add,delete) D cancel

D Users(Drive U) w
Er Users(Drive S)

1__ ~~" re __ol4 ·-·-·-···-·-· 4 ·--~~ore_ )r.Jo~h<,/f •..., __ (cohr- .._ ~

2 ~~w-c H{ t:
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s_fb.~t.~--~L-·--- 0' R
3.... _.~ t,re.1v1,, ·--· ~ H ~ t -··---····-·· 6 ~-~0..._ 1,,,., F .,._, ~ R
Remarks: R=Read Only,w,,write or change Pennision 1 ~/.p.r«ti.,10 P~ ~ ~
Mail/Web Access/other Comunication Request D New User D Change(add,delete) D Cancel

:J lntranet Mall ::::::: Jnteme.t Mail fl Web Access

Ma°llbox Group Mailbox Group C Other (MSN)
Old Group Old Group

ApPllcatlon Request: D NewUser CJ Change(add,delete) ::::J Cancel

Menu Permission List: a

1 I.vi!'/ 9
--------------~
] An;eq f!,e,,e 10 ----------------
_
3 !h,,..,.,;.., Ca~e .. lu Authorize Permission List:
4 Acc~,s r~"'...~ c..,,,, 1 _
5 \.l~ g \ ~ ... ,lit"~ Vco'fss:, sofoio8~it100021r 2
6 u~g Ge.....,.,. 1.ncs: c, 'z.. 3 _
7 4 ~

Requester/Super User: Depa enn anager Approve: Factory ManmAuthorlze:

~~,,..::,-
/ -
( H...r,-,°',., J0 •~ ) ( t,>iU,«"V ~\-" ) c ~ vH ~\11~1 Ckt.k~ ~.J
Date )Z --ob Z.:> 2 o Date 2?. 01.. :Z o Date t 5(o(/to
Administrator : D Approve D Reject

Network admfnlstrator Received Oate : Application Administrator Received Date:

Actioo: 0 Complete 0 Cancel Action: D Complete D cancel
5;-- Date Sign Date
( l Time ( ) Time
Computer lus'er II Port I Description Vend.or I Model II Serial ID I
PTJ-QHSEXX07-PC IPTJ\eko I Sandisk USB Ultra USB SAN"DISK 15567 I VC0435150702085361000235
llusB Device
Generic Mass-Storage
PTJ-QHSEXX07-PC PTJ\eko USB GENERIC 0226 6!2C5D2
USB Device