ITO FORM NO.

21
Republic of the Philippines
COMMISSION ON AUDIT
Commonwealth Ave., Quezon City

Information System Access Request

and User Certification (ISARUC)
Name of Information System:

Type of Request

Create an Account Deactivate Account Activate Account Modify Access Rights

Type of Access
Add/ Edit/ Delete Query Report
User Information
Office/Service Audit Group NGS 4A and B Team R5-07
Employee No. Last Name, First Name MI. Position/Designation
0261688
Salcedo, Daycel A. SA II

Requested By: (Immediate Supervisor) Approved By: (Head of Office)

CYNTHIA B. BARAJAS/SA IV Audit Team Leader
Name/Position
Name/Position
Date:10/06/2022
Date:10/06/2022

User’s Certification
I hereby certify that I understand that, by signing this Information System Access Request and User
Certification, I am solely responsible for the use and protection of the User ID and password that I will be
provided. I also understand that I am not authorized to share my User ID and password with anybody and I attest
specifically the following:

 I will not use the information I have accessed to in an unauthorized manner;

 I will neither knowingly include, nor cause to be included, a false or misleading entry in any
record;
 I will not change or delete any entry in any record unless it is authorized;
 I will not copy, reproduce, electronically print except in the performance of my duties; and
 I will not divulge, in any way, knowledge of any confidential information that I have learned.

I understand the intent of this statement and will exercise diligence in performing my duties in accordance
with the Guidelines on the Use of COA Information and Communications Technology (ICT) Resources. Further, I
agree that my failure to comply with the terms of this agreement will have consequences and may result in
disciplinary action up to immediate termination and criminal prosecution, depending upon the infraction's severity,
evidence of my intentions, and the sensitivity and scope of the information compromised.

That in case of any change in my job responsibilities, present assignment or employment status, I am
responsible to inform the concerned IS Administrator through submission of an updated ISARUC.

Signed in the presence of: (Immediate Supervisor)

DAYCEL A. SALCEDO CYNTHIA B. BARAJAS
Signature over printed name Signature over printed name

Date: 10/06/2022 Date:10/06/2022

For IS System Administrator

Action Taken:
Created User Account Deactivated Account Activated Account Modified Access Rights

___________________________
Signature over printed name Date: ______________ Remarks: _____________________________

Rev 9/2020
ITO FORM NO. 21

Rev 9/2020