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: 0503267186

Fax:
Nationality : PHILIPPINES

Email: jonathan.camba@dlps.net Designation: EHSM: CIRS INITIATE INCIDENT

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 INCIDENT ADD
2 INITIATES NEARMISS ADD
3
4
5

YES, I have read and accepted the Saudi Aramco Computer Use Agreement (NON-Employee) SA-9696
X

Jonathan F. Camba April 11, 2023

Applicant Printed Name and Signature Date

Section (C) Employer’s Information

Company Name & Stamp Saudi Aramco Registration ID/Contract or Date: 04/11/2023
PR # /Other
Diversified Lines for Petroleum Services (DLPS) 66000174980 Tel:

Section (D) APPROVAL – SPONSORING DEPARTMENT

Manager or Authorized Signature Approval Department Name Date Telephone
Name & Signature
FUTAIKHAN AL ANEZI, Manager Mega Projects OMPPD / HGUPD

Section (E) COMPLETED BY

Name Signature Date

Jonathan F. Camba April 11, 2023

* - Indicates Mandatory Field

Saudi Aramco: Company General Use

 Procedure for completing the SA 8205-5:
This form is required to request a Extranet User ID as well as grant access to Extranet applications deployed in Saudi Aramco Extranet
for individual users that are not employees of the Saudi Aramco company; such as Contractor employees, consultants, Joint Venture
employees, designated medical facility users, employees of Affiliates and Subsidiaries, or any non-employee who requires access to
Saudi Aramco Extranet applications and resources.
This form must be filled in conjunction with the SAUDI ARAMCO COMPUTER USE AGREEMENT (NON-EMPLOYEE) SA-9696.
Descriptions of the fields are as follows:
1 Last Name Camba
2 First Name Jonathan
3 M.I F.
4 Passport/NIN/Iqama #: 2539170585

5 Nationality Philippines
6 Tel & Fax: The Telephone and Fax Number of the User
7 Mobile 0506237186
8 Email jonathan.camba@dlps.net
9 Network ID Action Requested to Create a Network ID
10 Action Requested New network
ID.

11 Extranet Application Name Jonathan F. Camba

12 Application Administrator Administrator
13 Extranet Application Role EHSM: CIRS_INITIATE INCIDENT

14 Action Required ADD

15 Applicant Name and Signature: Jonathan F. Camba

16 Employer Name & Stamp: Diversified Line Petroleum Services (DLPS)

17 Saudi Aramco Registration ID / Contract No.: 66000174980

Contract or PR # / Other:

18 Date and Tel: 04/11/2023

19 Sponsoring Department Name FUTAIKHAN AL ANEZI, Manager Mega Projects
Manager or Authorized Signature
Approval:
20 Department Name OMPPD / HGUPD
21 Date 04-11-2023
22 Telephone
23 Name
24 Signature
25 Date April 11, 2023

Saudi Aramco: Company General Use