Part Submission Warrant Instructions

Part Name 1 Part Number 2

Safety and/or 3 4 Government Regulation Yes No Engineering Drawing Change Level Dated

Additional Engineering Changes 5 Dated

Shown on Drawing No. 6 Purchase Order No. 7 Weight 8 kg

Checking Aid No. 9 Engineering Change Level 10 Dated

SUPPLIER MANUFACTURING INFORMATION SUBMISSION INFORMATION 13

11 Dimensional Materials/Functional Appearance Supplier Name Supplier Code Customer Name/Division 14 12 Street Address Buyer/Buyer Code 15

Application 16 City/State/Postal Code

REASON FOR SUBMISSION 17

Initial Submission Change to Optional Construction or Material Engineering Change(s) Sub-Supplier or Material Source Change Tooling: Transfer, Replacement, Refurbishment, or additional Change in Part Processing Correction of Discrepancy Parts Produced at Additional Location

Other - please specify

REQUESTED SUBMISSION LEVEL (Check one) 18

Level 1 - Warrant, Appearance Approval Report (for designated appearance items only).

Level 2 - Warrant, Parts, Drawings, Inspection Results, Laboratory and Functional Results, Appearance Approval Report.

Level 3 - At Customer Location - Warrant, Parts, Drawings, Inspection Results, Laboratory and Functional Results, Appearance Approval Report, Process Capability Results, Capability Study, Process Control Plan, Gage Study, FMEA.

Level 4 - Per Level 3, but without parts.

Level 5 - At Supplier Location - Warrant, Parts, Drawings, Inspection Results, Laboratory and Functional Results, Appearance Approval Report, Process Capability Results, Capability Study, Process Control Plan, Gage Study, FMEA.

SUBMISSION RESULTS 19

The results for dimensional measurements material and functional tests and appearance criteria and statistical process package meet all drawing and specification requirements: Yes No (If “No” - Explanation Required) 20 DECLARATION

I affirm that the samples represented by this warrant are representative of our parts and have been made to the applicable customer drawings and specifications and in the case of production samples, are made from specified materials on regular production tooling with no operations other than the regular production process. I have noted any deviations from this declaration below:

EXPLANATION/COMMENTS: 21

Print Name Title Phone No.

Supplier Authorized Signature 22 Date

FOR CUSTOMER USE ONLY Part Disposition Approved Rejected Other

Customer Name Customer Signature Date

CFG-1001(4/15/96) D:\Docs\2018-05-03\080fc63cb2a977864b4dbbe45db89a10.doc Part Submission Warrant Instructions PART INFORMATION 1) Part Name and 2. Part Number: Engineering released finished end item part name and number.

3) Safety/Regulated Item: "Yes" if so indicated on part drawing, other wise "No"

4) Engineering Change Level & Approval Date: Show the change level and date for submission.

5) Additional Engineering Changes: List al authorized engineering changes not yet incorporated on the drawing but which are incorporated in the part.

6) Shown on Drawing Number: The design record that specifies the part number being submitted.

7) Purchase Order Number: Enter this number as found on the purchase order.

8) Part Weight: Enter the actual weight in kilograms to three decimal places.

9) Checking Aid No.: Enter the checking aid number, if one is used for dimensional inspection, and,

10) Its Engineering Change Level and Approval Date.

SUPPLIER MANUFACTUREING INFORMATION

11) Supplier Name & Supplier Code: Show the code assigned to the manufacturing location on the purchase order.

12) Supplier Manufacturing Address: Show the complete address of the location where the product was manufactured.

SUBMISSION INFORMATION 13) Submission type: Check box(es) to indicate type of submission.

14) Customer Name: Show the corporate name and division or operations group.

15) Buyer Name: and Buyer Code: Enter the buyers name and code.

16) Application: Enter the model year, vehicle name…etc (if applicable)

REASON FOR SUBMISSION 17)Check the appropriate box. Add explanatory details in the "other" section.

REQUESTED SUBMISSION LEVEL 18)Identify the submission level requested by your customer.

SUBMISSION RESULTS 19)Check the appropriate boxes for dimensional, material tests, appearance evaluation, and statistical data.

20)Check the appropriate box. If "no", enter explanation in "comments" below.

DECLARATION 21) Comments: Provide any explanatory details on the submission results; additional information may be attached as appropriate.

CFG-1001(4/15/96) D:\Docs\2018-05-03\080fc63cb2a977864b4dbbe45db89a10.doc Part Submission Warrant Instructions

22)The responsible supplier official, after verifying that the results show conformance to all customer requirements and that all required documentation is available will sign the declaration and provide Title and Phone Number.

FOR CUSTOMER USE ONLY Leave blank.

Reprinted with permission from the PPAP Manual (DaimlerChrysler, Ford, General Motors Supplier Quality Task Force).

CFG-1001(4/15/96) D:\Docs\2018-05-03\080fc63cb2a977864b4dbbe45db89a10.doc