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Augustea Ship Manning Philippines Inc.

Office of Information Technology

Administrative Systems Access Request

1. Complete the User Information Section with the name of the user or staff member requesting access.
all files are subject for monitoring and any act of abuse will be strictly prohibited

User Information
_______________________________ Signature: MABARQUEZ
First Name: MARFIL
Middle Initial: _______________________________ Phone: LOCAL 111
Department: _______________________________
Date: 03-15-2017
_______________________________ Email: MABARQUEZ@AUGUSTEA.COM

2. If the individual’s access is to be deleted, indicate the system(s) for which access should be removed
(Department Head, Director or Chair signature is required)
Remove Access

3. Indicate the systems to which the individual requires access and the type of access by circling the appropriate
system name and access type.

Allow Access

Type of Access Other =>

Description of Request

4. If requesting access to the system, provide the account numbers for which access being requested.

5. Once approved by the department’s Director or Chair, forward the request to the appropriate system
manager for approval and processing. Please note, if access to multiple systems is being requested, this form
must be sent to each system manager for approval.

Approval Name Signature

Office Manager Marjorie Dulay

6. System Manager please forward the completed form to Information Technology, Campus Box 161 for

For Information Technology Use Only

Date Completed: 15 march 2017 By: Jerson Cayabyab