You are on page 1of 1

User Access Management Form

User Name User email id User Role User NSN ID Cost Center Organization User Mobile Number Date of Submitting Other Employee ID Computer Name

Request Approvals
Name Approver 1 Approver 2 Approver 3 Designation Phone Email

Request Details
Type or Request Other Requests OSS Customer Network Access expires on Node/ Database NetAct (OSS) Read Only Read-Write Modify Administration Circle Create Delete Reset Access

DX/IP NE’s (Router access) Applications Required:

WAHA Login

Network Element /IT system

For Administrator USE
Node/ Database User ID Action Valid till

Request Completed by

Date