Celcom (Malaysia) Berhad

FORM B: Celcom Corporate SecureVPN Change

Request – SSLVPN (Vendor)

FORM B: Celcom Corporate SecureVPN Change Request – SSL VPN (for

Vendor/Partner)

Please send/email the Form with signature to IT Security Management.

Please fill in the information below for users/partners/customers request of change.

A - Requester’s Details

Internal Requester’s details (Celcom) External Requester’s details (Vendor)

Requester’s Requester’s
Roslan Mohamed Mohd.Lukmanul Hakim
Name Name
Department NETWORK QUALITY Company Huawei Technologies Co., Ltd

Division NQA-Mobile Network Dept/Div NPS

Direct Line +60372603457 Direct Line
Hand Phone +60192400000 Hand Phone +60135240881
Email roslanm@celcom.com.my Email mohdl.jemain@huawei.com
Note: All requests from non-Celcom personnel must be made through their Celcom’s counterpart

B – Project/Support Details

Project/Support Name: Celcom Hammer 2 Project

(Ex: Cisco Maintenance, IDM
Project, etc)
VPN Access Role: Project Implementation
Remote Monitoring
Remote Support
Remote Configuration Management
Others (Please specify):

VPN Access Duration: One (1) Month

Three (3) Months
Six (6) Months
One (1) Year
Others (Please specify):

C- Remote Access VPN Connection Request

Duration (Account
No Destination IP Port/Service to be Opened
Expiry Date)
1 10.1.116.4/5/6/7/8 U2K Port : 31039 1 year
2 10.1.117.8 U2K Port : 31943 1 year

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FORM B: Celcom Corporate SecureVPN Change
Request – SSLVPN (Vendor)

3 10.1.116.29 PRS Port: 8443 1year

4 10.1.117.128 MAE Port : 31943 1year
5 10.151.105.2/27 Discovery Port : 22/8443 1year
6 10.223.40.61/32 Utraffic Port :31943 1year
7 10.223.72.82 SEQ Port : 8443 1year
8 10.151.110.7:31943 SON Master Port: 31943 1year

Number of ID(s) to be created: 1

D- Justifications for Changes

To access VPN remotely for SSO project

Note: 1) Please attached supporting documents, if any (ex: CCMC, Project Paperwork, etc)
2) Please use additional paper if the field above is not sufficient

D- End-user Agreement

With this I agree to use this facility only for work-related activities, and am aware that access via this
infrastructure is logged and monitored.

I will ensure my computer system/PC used to access the SSL-VPN is free from virus, spyware, adware and
all other malicious programs that could propagate to Celcom internal network.

I also agree to safeguard the User ID provided by Celcom. Any misconduct/misbehavior associated
with this User ID will be under my responsibilities, and I agree to use this ID only for the above said
reason(s) only.

I fully understand that Celcom, due to security reasons, might reject this request.

Vendor’s signature: Requester’s signature: Request Approved by:

…………………………………… …………………………………… ……………………………………

Date: 2021/7/19 Date: Date:

Note: By default all requests have to be approved by the respective Head of Division (HOD). However do consult
IT Security Management first for the acceptable approval level.

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FORM B: Celcom Corporate SecureVPN Change
Request – SSLVPN (Vendor)

E - For Internal Use Only

IT Security Management Action: Accept Request

Reject Request

Reason(s) for Rejection:

Changes performed by: Remarks:

1) ID Created:

……………………………………….
( )
Date:

2) Roles:
Approved by:

……………………………………….
( )
Date:

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