Extranet User Access Request Form (SA 8205-5)

(NON-Saudi Aramco Employees)

Section (A) User Information
Last Name First Name Middle Name Saudi National ID ___________ Tel:

CAMBA JONATHAN FUENTES Iqama / Passport 2539170585 Mobile: 0506237186

Fax:
Nationality : PHILIPPINES

Email: Jonathan.Camba@dlps.net Designation: Safety Supervisor

Network ID : Create Delete NETWORK ID

APPLICATION ACTION REQUESTED: Add Modify Delete Renew Other (specify)
NETWORK ID

Section (B) Extranet Application Access

Extranet Application Name: Safe life Solutions Application Administrator: YES NO

*Extranet Application Role Action Required (Add/Remove)

1 INITIATES ACTION FOR INSPECTION ADD
2 INITIATES NEARMISS ADD
3 INITIATES INCIDENT ADD
4
5

Section (C) Employer’s Information

Company Name & Stamp Saudi Aramco Registration ID/Contract or Date: 13-FEB-2023
PR # /Other
DIVERSIFIED LINES PETROLEUM SERVICES 10024883 /6600044367 Tel:

Section (D) APPROVAL – SPONSORING DEPARTMENT

Manager or Authorized Signature Approval Department Name Date Telephone
Name & Signature

Section (E) COMPLETED BY

Name Signature Date

Saudi Aramco: Company General Use