Access request form v4

| | Please fill in this form and submit to the Service Desk via Maximo or send via email.Only Authorized Requestors are allowed to submit this form to the Service desk. For SAP requests, only Authorized Requestors for SAP is allowed to submit this form. | | 1. | Type of Request* | | Employee Status | New user Change existing user | Date of execution/present in the office: | | Employee Type | Permanent employee Internal Consultant (with Yara PC) External Consultant (without Yara PC) | Date for termination, if consultant: | | Bulk request | Bulk Request (For simple requests, up to 10 persons, skip section 2. see page 4) | 2. | Employee Information*(If user is consultant please specify external mail address and external company name) | | Yara ID | | | First Name(s) | | | Last Name(s) | | | Email address | | | Site ID or address | | | Company/Unit name | | 3. | Yara responsible person*(Line Manager, Business Contact, Project Manager) | | Yara ID | | | First name(s), Last name(s) | | 4. | Yara Authorized Requestor* Basic | Yara Authorized Requestor* SAP | | Yara ID | | Yara ID | | | First name(s), Last name(s) | | First name(s), Last name(s) | | 5. | Business justification*(Mandatory field if user is consultant) | | | | All fields in section 1, 2, 3, 4 and 5 are mandatory. | 6. | Access requirements – Standard Access | | Standard User * Active Directory (AD)(Including: TIM + Intranet + Maximo + TPMx + MS Communicator basic) * Lotus Notes Mail * Internet * Iron Mountain (laptop users) | AD account Notes/email account Internet Iron Mountain (for laptop users) | Model user: <Yara ID and/or name of user>(If you have a model user that can be copied) | | | If mail server is not Mail01, please specify mail server:<Example: Dom01 for Praxair users> | | Passwords/ID files* | Account information/ID file must be sent to: | | | Password must be