Reporter Name: 
Reporter Phone: 
Reporter Dept: 
Reporter Email:  
Partner Service Desk Ticket number: 

Affected End User Name: 
Affected End User BB Phone number: 
SIM Card number: 
Affected End User Email Address: 
Affected End User Network email User ID: 
iBES / AD account verified?  Y/N
Dept.: 

Activity description: 


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