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INNOVISTA RACHNA – MAINTENANCE REQUEST FORM
Date of Request: *
MM
/
DD
/
YYYY
Request ID :   *
(for Official Use)
Name:   *
(Requestor Details)
Company / Organization:   
Contact Number:    *
Email Address:    *
Membership Status:   
Location of Issue:   *
Required
SME Office No. / Private Office No. /Meeting/Conference Room No. *
(kindly specify specific number)
Type of Maintenance Required:   *
Required
Description of Issue: *
  (Please describe the issue clearly, including when and how it was noticed)  
Requestor's Signature:
(One can attach digital signature)
Add file
Received By:  *
(Office Use Only)
Assigned To:
(Technician)
Action Taken:
Date Resolved: *
MM
/
DD
/
YYYY
Remarks:
Priority Level:    *
Required
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