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1、,Part Submission Warrant,Part Name,Cust Part Number,Shown on Drawing No.,Org. Part Number,Engineering Change Level,Dated,Additional Engineering Changes,Dated,Safety and/or Government Regulation,_ Yes _ No, Purchase Order No.,Weight kg,Checking Aid No., Checking and Engineering Change Level,Dated,SUP
2、PLIER MANUFACTURING INFORMATION,CUSTOMER SUBMITTAL INFORMATION,Supplier Name & Supplier/Vendor Code,Customer Name/Division,Customer Name/Division,Buyer/Buyer Code,Street Address,Application,City Region Postal Code Country,MATERIALS REPORTING,Has customer-required Substances of Concern information be
3、en reported,Yes,No,n/a,Submitted by IMDS or other customer format: ,Are polymeric parts identified with appropriate ISO marking codes,Yes,No,n/a,REASON FOR SUBMISSION (Check if at least one),_ Initial Submission,_ Change to Optional Construction or Material,_ Engineering Change(s),_ Sub-Supplier or
4、Material Source Change,_ Tooling; Transfer, Replacement, Refurbishment, or additional,_ Change in Part Processing,_ Correction of Discrepancy,_ Parts Produced at Additional Location,_ Tooling Inactive than 1 year,_ Other - please specify,REQUESTED SUBMISSION LEVEL (Check one),_ Level 1 - Warrant onl
5、y (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 a
6、nd other requirements as defined by customer.,_ Level 5 - Warrantwith product samples and complete supporting data reviewed at suppliers manufacturing location.,SUBMISSION RESULTS,The results for _ dimensional measurements _ material and functional tests _ appearance criteria _ statistical process p
7、ackage,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 this warrant are representative of our parts, which were made by a process that meets all Pro
8、duction 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?,_ Yes _ No,Organization Authorized Signature ,Date,Print Name , Phone No., FAX No.,Title,Email,FOR CUSTOMER USE ONLY (IF APP
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