Part Submission Warrant

Part Name Cust. Part Number

Shown on Drawing No. Org. Part Number
Engineering Change Level Dated
Additional Engineering Changes N/A ---- Dated
Safety and/or Government Regulation Purchase Order No. Weight (gms) 166
Checking Aid No. Checking Aid Engineering Change Level Dated N/A
ORGANIZATION MANUFACTURING INFORMATION
POOJA FORGE LTD.
Customer Name/Division
Unit-III, 49.8 Mathura Road, NH-2 ---
Street Address Buyer/Buyer Code
Faridabad, Haryana 121102 INDIA ---
City Region Postal code Application
MATERIALS REPORTING
Has customer-required Subtances of Concern information been reported?
Submit by IMDS or other customer format:
if submitted by IMDS, enter Module ID Number,Version and date transmitted IMDS No.-36558
Are polymeric parts identified with appropiate ISO marking codes?
REASON FOR SUBMISSION (Check at least ones)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) Supplier or 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 only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at organization'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: (If "NO" - Explanation Required)
Mold / Cavity / Production Process Cold Forging & Related Processes
DECLARATION
EXPLANATION/COMMENTS:
Is each Customer Tool properly tagged and numbered?
Organization Authorized Signature Date
Print Name Phone No. FAX No. +91-1275-262906
Title Manager (Q A) E-mail [email protected]
FOR CUSTOMER USE ONLY (IF APPLICABLE)
Part Warrant Disposition:
Customer Signature Date
Customer Name Customer Tracking Number(optional)
CFG-1001
---
120-B00205-69C
N/A N/A
M16 x 2.0 x 90.0, HEX BOLT AF061941
AF061941 ------
ARUN KUMAR +91-1275-262973
CUSTOMER SUBMITTAL INFORMATION
ANIXTER FASTENERS UK
I 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 the production rate of 60000/10 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
22/5/2011
Organization Name & Supplier/Vendor Code
Country
Yes No
Yes No
Yes n/a
Yes
No
Approved Rejected Other
No
n/a
Yes No n/a
Part Submission Warrant
Part Name Cust. Part Number
Shown on Drawing No. Org. Part Number
Engineering Change Level Dated
Additional Engineering Changes N/A ---- Dated
Safety and/or Government Regulation Purchase Order No. Weight (gms) 134
Checking Aid No. Checking Aid Engineering Change Level Dated N/A
ORGANIZATION MANUFACTURING INFORMATION
POOJA FORGE LTD.
Customer Name/Division
Unit-III, 49.8 Mathura Road, NH-2 ---
Street Address Buyer/Buyer Code
Faridabad, Haryana 121102 INDIA ---
City Region Postal code Application
MATERIALS REPORTING
Has customer-required Subtances of Concern information been reported?
Submit by IMDS or other customer format:
if submitted by IMDS, enter Module ID Number,Version and date transmitted IMDS No.-36558
Are polymeric parts identified with appropiate ISO marking codes?
REASON FOR SUBMISSION (Check at least ones)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) Supplier or 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 only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at organization'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: (If "NO" - Explanation Required)
Mold / Cavity / Production Process Cold Forging & Related Processes
DECLARATION
EXPLANATION/COMMENTS:
Is each Customer Tool properly tagged and numbered?
Organization Authorized Signature Date
Print Name Phone No. FAX No. +91-1275-262906
Title Manager (Q A) E-mail [email protected]
FOR CUSTOMER USE ONLY (IF APPLICABLE)
Part Warrant Disposition:
Customer Signature Date
Customer Name Customer Tracking Number(optional)
CFG-1001
---
120-B0212-69C
N/A N/A
M16 x 2.0 x 70.0 , HEX BOLT AF061940
AF061940 ------
ARUN KUMAR +91-1275-262973
CUSTOMER SUBMITTAL INFORMATION
ANIXTER FASTENERS UK
I 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 the production rate of 60000/10 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
22/5/2011
Organization Name & Supplier/Vendor Code
Country
Yes No
Yes No
Yes n/a
Yes
No
Approved Rejected Other
No
n/a
Yes No n/a
Part Submission Warrant
Part Name Cust. Part Number
Shown on Drawing No. Org. Part Number
Engineering Change Level Dated
Additional Engineering Changes N/A ---- Dated
Safety and/or Government Regulation Purchase Order No. Weight (gms) 126
Checking Aid No. Checking Aid Engineering Change Level Dated N/A
ORGANIZATION MANUFACTURING INFORMATION
POOJA FORGE LTD.
Customer Name/Division
Unit-III, 49.8 Mathura Road, NH-2 ---
Street Address Buyer/Buyer Code
Faridabad, Haryana 121102 INDIA ---
City Region Postal code Application
MATERIALS REPORTING
Has customer-required Subtances of Concern information been reported?
Submit by IMDS or other customer format:
if submitted by IMDS, enter Module ID Number,Version and date transmitted IMDS No.-36558
Are polymeric parts identified with appropiate ISO marking codes?
REASON FOR SUBMISSION (Check at least ones)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) Supplier or 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 only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at organization'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: (If "NO" - Explanation Required)
Mold / Cavity / Production Process Cold Forging & Related Processes
DECLARATION
EXPLANATION/COMMENTS:
Is each Customer Tool properly tagged and numbered?
Organization Authorized Signature Date
Print Name Phone No. FAX No. +91-1275-262906
Title Manager (Q A) E-mail [email protected]
FOR CUSTOMER USE ONLY (IF APPLICABLE)
Part Warrant Disposition:
Customer Signature Date
Customer Name Customer Tracking Number(optional)
CFG-1001
---
120-B00204-69C
N/A N/A
M16 x 2.0 x 65.0 , HEX BOLT AF064723
AF064723 ------
ARUN KUMAR +91-8901412344
CUSTOMER SUBMITTAL INFORMATION
ANIXTER FASTENERS UK
I 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 the production rate of 60000/10 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
30/5/2011
Organization Name & Supplier/Vendor Code
Country
Yes No
Yes No
Yes n/a
Yes
No
Approved Rejected Other
No
n/a
Yes No n/a
Part Submission Warrant
Part Name Cust. Part Number
Shown on Drawing No. Org. Part Number
Engineering Change Level Dated
Additional Engineering Changes N/A ---- Dated
Safety and/or Government Regulation Purchase Order No. Weight (gms) 8
Checking Aid No. Checking Aid Engineering Change Level Dated N/A
ORGANIZATION MANUFACTURING INFORMATION
POOJA FORGE LTD.
Customer Name/Division
Unit-III, 49.8 Mathura Road, NH-2 ---
Street Address Buyer/Buyer Code
Faridabad, Haryana 121102 INDIA ---
City Region Postal code Application
MATERIALS REPORTING
Has customer-required Subtances of Concern information been reported?
Submit by IMDS or other customer format:
if submitted by IMDS, enter Module ID Number,Version and date transmitted IMDS No.-36558
Are polymeric parts identified with appropiate ISO marking codes?
REASON FOR SUBMISSION (Check at least ones)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) Supplier or 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 only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at organization'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: (If "NO" - Explanation Required)
Mold / Cavity / Production Process Cold Forging & Related Processes
DECLARATION
EXPLANATION/COMMENTS:
Is each Customer Tool properly tagged and numbered?
Organization Authorized Signature Date
Print Name Phone No. FAX No. +91-1275-262906
Title Manager (Q A) E-mail [email protected]
FOR CUSTOMER USE ONLY (IF APPLICABLE)
Part Warrant Disposition:
Customer Signature Date
Customer Name Customer Tracking Number(optional)
CFG-1001
---
120-B00204-69C
N/A N/A
M8 x 1.25 x12 , HEX SCREW AF000380
AF000380 ------
ARUN KUMAR +91-8901412344
CUSTOMER SUBMITTAL INFORMATION
ANIXTER FASTENERS UK
I 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 the production rate of 60000/10 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
19/5/2011
Organization Name & Supplier/Vendor Code
Country
Yes No
Yes No
Yes n/a
Yes
No
Approved Rejected Other
No
n/a
Yes No n/a
Part Submission Warrant
Part Name Cust. Part Number
Shown on Drawing No. Org. Part Number
Engineering Change Level Dated
Additional Engineering Changes N/A ---- Dated
Safety and/or Government Regulation Purchase Order No. Weight (gms) 14
Checking Aid No. Checking Aid Engineering Change Level Dated N/A
ORGANIZATION MANUFACTURING INFORMATION
POOJA FORGE LTD.
Customer Name/Division
Unit-III, 49.8 Mathura Road, NH-2 ---
Street Address Buyer/Buyer Code
Faridabad, Haryana 121102 INDIA ---
City Region Postal code Application
MATERIALS REPORTING
Has customer-required Subtances of Concern information been reported?
Submit by IMDS or other customer format:
if submitted by IMDS, enter Module ID Number,Version and date transmitted IMDS No.-36558
Are polymeric parts identified with appropiate ISO marking codes?
REASON FOR SUBMISSION (Check at least ones)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) Supplier or 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 only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at organization'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: (If "NO" - Explanation Required)
Mold / Cavity / Production Process Cold Forging & Related Processes
DECLARATION
EXPLANATION/COMMENTS:
Is each Customer Tool properly tagged and numbered?
Organization Authorized Signature Date
Print Name Phone No. FAX No. +91-1275-262906
Title Manager (Q.A) E-mail [email protected]
FOR CUSTOMER USE ONLY (IF APPLICABLE)
Part Warrant Disposition:
Customer Signature Date
Customer Name Customer Tracking Number(optional)
CFG-1001
ARUN KUMAR +91-1275-262973
CUSTOMER SUBMITTAL INFORMATION
ANIXTER FASTENERS UK
I 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 th
8/5/2011
Organization Name & Supplier/Vendor Code
Country
N/A N/A
M8 x 1.25 x 25 , FLANGE SCREW C-3093730
C-3093730 ------
---
120-B00266-32E
Yes No
Yes No
Yes n/a
Yes
No
Approved Rejected Other
No
n/a
Yes No n/a
Part Submission Warrant
Part Name Cust. Part Number
Shown on Drawing No. Org. Part Number
Engineering Change Level Dated 30-06-2012
Additional Engineering Changes N/A ---- Dated ---
Safety and/or Government Regulation Purchase Order No. Weight (Kg.) 0.1500 Kg.
Checking Aid No. Checking Aid Engineering Change Level Dated N/A
ORGANIZATION MANUFACTURING INFORMATION
ARC Machine Tools (P) Ltd./IPMOA029
Customer Name/Division
16/5 Karkhana Bagh, Mathura Road, Faridabad.
Street Address Buyer/Buyer Code
Faridabad NCR India Suzuki Diesel / Fiat Diesel
City Region Postal code Application
MATERIALS REPORTING
Has customer-required Subtances of Concern information been reported?
Submit by IMDS or other customer format: PRD-F-12
if submitted by IMDS, enter Module ID Number,Version and date transmitted IMDS No.-36558
Are polymeric parts identified with appropiate ISO marking codes?
REASON FOR SUBMISSION (Check at least ones)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) Supplier or 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 only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at organization'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: (If "NO" - Explanation Required)
Mold / Cavity / Production Process CNC Turning & Related Processes
DECLARATION
EXPLANATION/COMMENTS:
Is each Customer Tool properly tagged and numbered?
Organization Authorized Signature Date
Print Name Phone No. FAX No. 0129-4044364
Title Director ( Techinical ) E-mail [email protected], [email protected]
FOR CUSTOMER USE ONLY (IF APPLICABLE)
Part Warrant Disposition:
Customer Signature Date
Customer Name Customer Tracking Number(optional)
Mr. Prem Kumar 0129-2296070
CUSTOMER SUBMITTAL INFORMATION
M/S Shriram Piston & Rings Ltd./GZB.
I 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 the production rate of 290 Pcs./ 8 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
25.09.2013
Organization Name & Supplier/Vendor Code
Country
121001
Rajiv Kumar
QMD-F-04 N/A
Pin Blank G-02-860
G-02-860 AMT/SRP/G-02-860
006
3900086747
Yes No
Yes No
Yes n/a
Yes
No
Approved Rejected Other
No
n/a
Yes No n/a