Xcavate IAM Access Request Form

Aligned with NIST SP 800-53r5 (Access Control family) and FCA compliance expectations

Document Version: 1.0 Classification: Internal Reviewed by: [Security/IT Team] Effective Date: [Insert Date]

Section 1: Requester Details

Field	Input
Full Name
Job Title
Department/Business Unit
Manager/Supervisor Name
Employee ID
Email Address
Phone Number

Section 2: Access Request Type

Please select the appropriate access type:

• New Access

• Access Modification

• Access Removal

• Temporary Access (Expires: //____)

Section 3: System/Resource Access Required

List the systems, data, or applications you require access to:

System/Application	Access Level (Read/Write/Admin)	Justification for Access

Section 4: Access Duration (For Temporary Access Only)

Start Date	End Date

Section 5: Data Sensitivity and Risk Acknowledgement

• I acknowledge that access to systems and data is granted for business purposes only.

• I will comply with Xcavate’s Acceptable Use Policy, Information Security Policy, and Data Handling Guidelines.

• I understand that any misuse of access will be subject to disciplinary action.

Requester Signature: ___________________ Date: //____

Section 6: Approvals

Role	Name	Signature	Date
Line Manager
System Owner/Data Owner
IT Security Reviewer
IAM Administrator (Final Approval)

Section 7: IT Use Only

Field	Input
Access Provisioned By
Provision Date
Accounts Created (Yes/No)
Privileged Access Logged?	Yes / No
Added to IAM Register?	Yes / No
Ticket/Change Reference ID

Notes:

• All forms must be retained for audit and compliance (FCA/NIST) purposes.

• Reviews of access permissions are conducted quarterly.

• This form is to be submitted to: [email protected]