Logged By:

Work order no : REQUEST FOR NEW USER ACCOUNT / UPDATE ACCOUNT DETAILS / TERMINATION

Person Details
Surname: Full Names: Username Directorate: Job Title: : Access needed for: Email Internet. VPN.. E-Venus PayDay PayDay Self service.. Suprima [Prepaid electricity] Cash drawer GIS Intenda. TEAS VoIP Cisco phone. Tetra radio.. Computer Lock.. Telephone No: Room Number: Building: Computer Make: Barcode Number: Other (equipment) Other equipment Other equipment ( ) First Name: Employee No: Current Username: Sub Directorate Employee Status: Other Systems Y Y Y Y Y Y Y Y Y Y Y Y Y Y [ [ [ [ [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] ] ] ] ] N N N N N N N N N N N N N N [ [ [ [ [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] ] ] ] ] ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Mobile No: Floor No: Town: Y [ ] N [ ] Y [ ] N [ ] Y [ ] N [ ] Y [ ] N [ ] Y [ ] N [ ] Y [ ] N [ ] Y [ ] N [ ] Full Time Part Time Fulltime Councilor

Workstation Details
Computer Model: Serial No:

Application Type
New Application [ ] Update Details [ ] Re-Application [ ] Termination [ ] Reason: (NB: MM approval required if access revoked) Acceptance of Municipality ICT Policies : Policies are available at ICT Helpdesk or on the MLM Intranet and by starting your computer and by clicking OK, you declare that you understand and agree to comply. Signatures Requested By Applicant Recommended By Direct Supervisor Approved By SM/GM/MM Authorised By Senior Manager: ICT Name Signature Date Name Signature Date Name Signature Date Name Signature Date