PSW 6

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Part Submission Warrant

Part Name

Cust. Part Number

Shown on Drawing No

Org. Part Number

Engineering Change Level

Dated

Additional Engineering Changes


Safety and / or
Govermment Regulation

Dated
Yes

Purchase Order No.

No

Checking Aid No

Weight (Kg )

Checking Aid Engineering Change Level

Dated

ORGANIZATION MANUFACTURING INFORMATION


Supplier Name & Supplier/Vendor Code

Customer Name / Division


New Swan Auto Comp (P) Ltd.
Buyer / Buyer Code

Street Address
City

Region

Postal Code

Application

Country

MATERIALS REPORTING
Has customer required Substances of Concern Information been reported ?

Yes

No

N/A

Yes

No

N/A

Submitted by IMDS or other customer format:

Are polymeric parts identified with appropriate-ISO marking codes ?


REASON FOR SUBMISSION (Check at least one)
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 specity

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 defind by customer .


Level 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing location
SUBMISSION RESULTS

Material & functional tests

These results meet all drawing and specification requirements

Yes

The results for

Dimensional measurements

Mold / Cavity / Production Process

Appearance critenia
No

Statical process package

( If NO - Explanation Required )

Production Process

DECLARATION
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 4 th Edition Requirements I further affirm that these samples were produced at the production
rate 200 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 .
EXPLANATION / COMMENTS :
Is each Customer Tool property tagged and numbered ?
OrganistionAuthorized Signature
Print Name

Yes

No
Date
Fax No

Phone No
FOR CUSTOMER USE ONLY ( IF APPLICABLE )

Part Warrant Disposition:


Customer Signature
Print Name

Approved

Rejected

Other
Date

Customer Tracking Number (optional)

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