Date

........................................................................................................................
BRANCH / DIVISION / OFFICE

USER ID REQUEST FORM FOR

ACTIVE DIRECTORY DOMAIN SERVICES (ADDS)

USER’S FULL NAME

DESIGNATION

WORKSTATION’S NAME

IP ADDRESS

PIBS USER ID

EMAIL

PERSONAL FILE NO.

......................................... .........................................
Signature of the User Signature of
Branch/Division/Office

FOR THE USE OF INFORMATION TECHNOLOGY DIVISION

We, the undersigned opened the User ID .................................................... on .........../.........../............

for the user as given above with the due deligence and proper verification.

......................................... ........................................................
Signature of Desk Official Signature of System Administrator

Name: Name:
Designation: Designation:
Date: / / Date: / /