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__ Change to Optional Construction or Material __ Sub-Supplier or Material Source Change __ Change in Part Processing __ Parts Produced at Additional Location __ Other - please specify
I hereby affirm that the samples represented by this warrant are representative of our parts, which were made by a process that meets all Production Part Approval Process Manual 4th Edition Requirements. I further affirm that these samples were produced at thed production rate of ____ / ___ hours. I also certify that documented evidence of such compliance is on file and available for review. I have noted any deviations from this declaration below.
EXPLANATION/COMMENTS: Is each Customer Tool properly tagged and numbered? Organization Authorized Signature Print Name Title Phone No. Email FOR CUSTOMER USE ONLY (IF APPLICABLE) Part Warrant Disposition: __ Approved __ Rejected __ Other Customer Signature Print Name Customer tracking Number (optional) Date FAX No. __ Yes __ No Date
ຫໍສະໝຸດ Baidu
CUSTOMER SUBMITTAL INFORMATION Customer Name/Division Buyer/Buyer Code Application
MATERIALS REPORTING Has customer-required Substances of Concern information been reported Submitted by IMDS or other customer format: Are polymeric parts identified with appropriate ISO marking codes REASON FOR SUBMISSION (Check if at least one) __ Initial Submission __ Engineering Change(s) __ Tooling; Transfer, Replacement, Refurbishment, or additional __ Correction of Discrepancy __ Tooling Inactive > than 1 year REQUESTED SUBMISSION LEVEL (Check one) __ Level 1 - Warrant only (and for designated appearance items, an Appearance Approval Report) submitted to customer. __ Level 2 - Warrant with product samples and \imited supporting data submitted to customer. __ Level 3 - Warrant with product samples and complete supporting data submitted to customer. __ LeveI 4 - Warrant and other requirements as defined by customer. __ Level 5 - Warrantwith product samples and complete supporting data reviewed at supplier's manufacturing location. SUBMISSION RESULTS The results for __ dimensional measurements __ material and functional tests __ appearance criteria __ statistical process package These results meet all drawing and specification requirements; __ Yes __ NO (If "NO" - Explanation Required) Mold / Cavity / Production Process DECLARATION
Part Submission Warrant
Part Name Shown on Drawing No. Engineering Change Level Additional Engineering Changes Safety and/or Government Regulation Checking Aid No. SUPPLIER MANUFACTURING INFORMATION Supplier Name & Supplier/Vendor Code Customer Name/Division Street Address City Region Postal Code Country __ Yes __ No Purchase Order No. Checking and Engineering Change Level Cust Part Number Org. Part Number Dated Dated Weight kg Dated