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Information Technology Services Office

Application for Restricted Access VPN Service for vendors


 

Jira case No.:

e.g. ITSD-12345

(This question is mandatory)

Type of Request

(This question is mandatory)

NetID:

(This question is mandatory)

Name of Applicant (Staff Only):

(This question is mandatory)

Contact Phone No.:

(This question is mandatory)
Department:

Part A: VPN User Information

(This question is mandatory)

Purpose of Application:

(This question is mandatory)

VPN User Full Name:

(This question is mandatory)

Vendor Company Name:

Part B: Host Information

(This question is mandatory)

Existing NetID of the VPN User:

(This question is mandatory)

Web URL / Host Name / IP Address and Port. e.g.

 

https://intranet-app-dept.polyu.edu.hk

hkpx900001.polyu.edu.hk:8443

hkpx900001.polyu.edu.hk:22

hkpx900002.polyu.edu.hk:8443

hkpx900002.polyu.edu.hk:22

Note: request to access servers with production data is prohibited

(This question is mandatory)

Part C: Service period

(This question is mandatory)
From:
Open date/time selector
(This question is mandatory)

To (Max 14 Days for planned task. Max 90 days for project implementation / service work requiring repeated access):

Open date/time selector

Please provide supporting reasons for requesting access beyond 14 days.

Endorser Information

(This question is mandatory)

Name of Department Head:

(This question is mandatory)
Email of Department Head:
(This question is mandatory)

Name of Department CLO:

(CLO information can be found at https://polyuit.sharepoint.com/sites/IAMLIST/Lists/List%20of%20CLOs/AllItems.aspx)

(This question is mandatory)
Email of CLO:
(This question is mandatory)

Contact phone number of CLO:

Additional Contact Email (Optional):

Note:

  1. After the form is submitted, we will send EMAIL to notify all endorsers (including department head) about your application request.
  2. We shall contact the applicant within 2 working days after receiving a properly completed form.
  3. Applicant has full responsibility to inform ITS of revoking this firewall setting immediately when it is no longer required through submitting an application by using this same registration form.

 

 
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