PART SUBMISSION WARRANT
Part Name …………………………………………………………………………...Part nubber…………………………………………………………
Safety and/or
Government Regulation Yes No Engineering Drawing Change Level……………………………Date………………………….
Additional Engineering Changes…………………………………………………………………………………………Date…………………….……..
Shown on Drawing No………………………………………….…Purchase Order No……………………..Weight(kg) ……………………….………
Checking Aid No……………………………………………Engineering Change Level ………………………….Date…………………………………
SUPPLIER MANUFACTURING INFORMATION SUBMISSION INFORMATION
……………………………………………………………………… Dimensional Materials/Functional Appearance
Supplier Name&Supplier Code Customer Name/Division……………………………….………………
………………………………………………………. ………. ………. Buyer/Buyer Code………………………………………………………
Street Address Application………………………………………………. …………….
………………………………………………………………………….
State Zip
Note: Does this part contain many restricted or reportable substances Yes No
Are plastic parts identified with appropriate ISO markting codes Yes No
REASON FOR SUBMISSION
Initial Subnission C Change to Optional Construction or Material
Engineering Change(s) Sub-Supplier or Material Source Change
Tooling:Transfer,Replancement,refurbidhment,or additional Change in Part Processing
Correction of Discrepancy Parts Produced at Additional Location
Toolling Inactive > than 1 year Other – please specify
REQUESTED SUBMISSION LEVEL (Chock one)
Level1–Warrant only (and for desingnated appearance items,an Appearance Approval Report) submitted to customer
Level2 - Warrant with product samples and limited supporting data submitted to customer.
Level3 – Warrant with product samples and complete supporting data submitted to customer.
Level4 – Warrant and other requirments as defined by customer.
Level5 – Warrant and product samples and complete supporting data reviewed at supplier’s manufacturing location.
SUBMISSION RESULTS
The results for dimensional measurements material and functional test
Appearance criteria statistical process package
These results meet all drawing and specification requirements: Yes No (If “No” Explanation Required)
Mold/Cavity/Production Process…………………………………………………………………………………………………..…
DECLARATION
I hereby affirm that the samples represented by thid warrant are representative of our parts,have been made to the applic
Pordcution Part Approval Process Manual 3rd Edition Requirements. I further warrant there sample are
Produced at production rate of……./8 hours. I have noted by deviations from this declaration below.
EXPLANATION/COMMENTS:……………………………………………………………………………………………………..
Print Name………………………………Title…………………..…Phone No…. …………………Fax No. ………………………..
Supplier Authorized Signature………………………………………………………………Date…………………………………..
………………………………………………………………………………………………………………………………………
¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬ FOR CUSTIOMER USE ONLY (IF APPLICABLE)
Part Warrant Deposition: Approed Rejected Part Functional Approval Approved
Other Waived
Customer Name…………………………………. ………Customer Signature……………………………. Date………………………….