NETgear Change Request Form

Version: 0.1

Change Request Form

Document Number: [XXX]/CRF-AST/NG/YYYY

Requester *
Requester personal information.
Name
NIK
Phone Number
Email
Superior
Division & Group

Request Approver *
Approval information.
Name Title Date Signature
Requester

AVP

VP

Objective Request*
Main objective of request.

Expected RFS Date*

Expected date request is finished. E.g.: 01-Jan-2021
Date :

Request Type*
Type of request based on category of request, platform, and module.
Please give mark (X) in the checkbox column based on request type.
Description Platform Checkbox
Mockup Web
Mobile
Additional Module Web
Mobile
Change Approval Web
Mobile

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Version: 0.1

Module Checkbox
NETgear Material On Site
NETgear Movement & Collection
NETgear Physical Count
NETgear Replacement
NETgear Maintenance
NETgear BABT
MR Online
NETgear Acceptance
NETgear NDB
NETgear IT
NETgear Insurance
Other, …

Request Description (Completed with data flow if any) *

Detail information regarding changes. In this section, you can attached data flow if available.

Stakeholder
Party that will be affected with the changes. E.g.: Asset Management Group, Finance, etc. Will be used
as approval staging and/notification
Stakeholder 1 R/A/C/I
Stakeholder 2 R/A/C/I
Stakeholder 3 R/A/C/I
Stakeholder 4 R/A/C/I
Stakeholder 5 R/A/C/I

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Version: 0.1

Expected Mockup (Picture)

Mockup or wireframe submitted by requester to provide an overview of the request.

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*Mandatory fields
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Version: 0.1

Supporting Document (Business Process / Flowchart / Other Document) *

List of Supporting document to provide additional information of request. Must be attached along with
this request document & IOM from Requester to VP Asset Safeguarding & Tracking
1
2
3
4
5

Glossary
List of terms or words related to the request.

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Version: 0.1

Part of AMG Development Team

(Filled by AMG Developer Team)

Consideration (1 to 3/Low to High)

.
Request Clarity
Resource Consumed
Impact to Asset

Recommendation
.
Need to be developed y/n
Timeline to Develop Xxx Man Days
Notes

5
*Mandatory fields