DPCICTF003
Smartphone and Tablet Request Form
4 FINANCIAL INFORMATION Device purchase price
$
Mobile Data Carriage Service Plan charge (per month)
$
SAGEMS Mobility Service charge (per month)
$
Shared Services support charge per month (if applicable)
$
Business Unit Cost Centre
5
-
-
Approximate annual charges
$
-
APPLICANT’S DECLARATION I have read and understood the Smartphone and Tablet Policy and agree to abide by the policy provisions contained therein.
SIGNATURE
DATE
6 EXECUTIVE DIRECTOR’S APPROVAL APPROVAL STATUS
APPROVED
CONDITIONALLY APPROVED
REJECTED
I support the business requirements identified and therefore endorse this request, and acknowledge that all relevant costs arising will be met from existing budgets.
NAME
FIRST NAME
LAST NAME
JOB TITLE SIGNATURE
DATE
7 QUESTIONS AND FORWARDING ADDRESS For any further enquiries, please call ICT Strategy on 846 35639 (35639 internal) and upon completion of the form, please forward to ICT Strategy, Level 12, State Administration Centre or fax to 8226 9421.
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