EGS-1
Application for New E-mail Account

Please fill in all necessary particulars to expedite processing. If there are more than five applicants, please submit your application in batches. You may return to this form again after your first and subsequent submissions and only change the particulars of the applicants and re-submitting again.

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Particulars of Agency:

Name of Agency
Address
Town
Post Code
Phone
FAX
URL

Particulars of Applicants:

Name
Position
Division
Phone
Name
Position
Division
Phone
Name
Position
Division
Phone
Name
Position
Division
Phone
Name
Position
Division
Phone

Name of CIO or Person Making This Application:

Name
E-mail
Phone

Concurrence of SUT/HOD:

Name
E-mail

Copyright © 1998
Unit Kamajuan IT Negeri
Kementerian Pembangunan Sumber dan
Kemajuan Teknologi Maklumat
Last revised: 14 March 2005
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