5.FM-ENG-05 Part Submission Warrant

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PART SUBMISSION WARRANT

PAGE 01 OF 01

Part Name _____ Part Number _________________________________


Safety and/or
Government Regulation Yes No Engineering Drawing Change Level _________ Dated
Additional Engineering Changes _ No
Shown on Drawing No. _ __ Purchase Order No. -------------____Weight (kg) _________
Checking Aid No. ______________________ Engineering Change Level ______________ Dated________________

SUPPLIER MANUFACTURING INFORMATION SUBMISSION INFORMATION


___________________________________________ Dimensional Materials/Functional Appearance
Supplier Name & Supplier Code
R&N TECHAUTO PVT. LTD.
Customer Name/Division_
Street Address
Plot no-84,Fulsungi,Tranjist Camp,Gangapur Road,Rudrapur Buyer/Buyer Code __ Mr.
Distt - Udham Singh Nagar
City Rudrapur State Uttarakhand

Note : Does this part contain any restricted or reportable substances. Yes No
Are plastic parts identified with appropriate ISO marking codes. Yes No

REASON FOR SUBMISSION


Initial Submission Change to Optional Contruction 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
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 supplier's manufacturing location.

SUBMISSION RESULTS
The result for dimensional measurments material and functional tests appearance criteria statistical process package.

These results meet all drawing and specification requirements: Yes No (If "No" - Explanation Required)
Mold/Cavity/Production Process __ SHOWN IN CONTROL PLAN

DECLARATION
I hereby affirm that the samples represented by this warrant are representative of our parts, have been made to the
applicable Production Part Approval Process Manual 3rd Edition Requirements. I further warrant these samles were
produced at the production rate of _________/8 hours. I have noted any deviations from this declaration below.

EXPLANATION/COMMENTS: ____________________________________________________________________

Print Name _____________________ Title ________________ Phone No.____________ Fax No._____________


Supplier Authorized Signature _________________________________________ Date ____________________

FOR CUSTOMER USE ONLY (IF APPLICABLE)


Part Warrant Disposition: Approved Rejected Part Functional Approval: Approved
Other Waived

Customer Name Customer Signature Date

FM-ENG-05

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