IT Service Request Form

Tell us what happened and the IT team will follow up using the contact details you provide.

01Requester information

Full Name *

First Name Last Name

Employee ID / NIK Department * E-mail * Use your active work e-mail address Contact Number Work Location * Building / Floor / Room *

02Problem category

Select all that apply.

Computer / Laptop Network / Internet E-mail / Account Printer / Peripheral Phone / Communication Software / Application Access / Permission Other

03Issue details Please Specify * 0 / 1,500

Priority Level *

NormalWork can continue HighWork is interrupted CriticalBusiness-critical impact

Screenshot / Supporting File Choose attachment JPG, PNG, WEBP, or PDF — maximum 5 MB

By submitting this form, you confirm that the information above is accurate.

Thank you. Your ticket has been created.