Part Submission Warrant

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DaimlerChrysler Part Submission Warrant

Part Name:       Customer Part Number:     


Shown on Drawing No.:       Organization Part #:demo      
Engineering Change Level:       Dated:      
Additional Engineering Changes:      Dated:      
demoSafety and / or Government Regulation: Yes No Purchase Order No.:       Weight (kg):      
Checking Aid No. :       Checking Aid Engineering Change Level:       Dated:     
Organization Manufacturing Information demoCustomer Submittal Information
           
Organization Name & Supplier/Vendor Code Custome Name/Division

           
Street Address Buyer / Buyer Code

           
City / Region / Postal Code / Country Application

Materials demoReporting
Has customer-required Substances of Concern information been reported? Yes No n/a
Submitted by IMDS or other customer format:      
     
Ihre Firma GmbH – Kundenstrasse 1 – D-XXXXX

Are polymeric parts identified with appropriate ISO marking codes? Yes No n/a

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 specify below :      

Requested demoSubmission 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 Yes No (if "No" - Explanation Required)
Mold / Cavity / Production Process:      

demoDeclaration:
I hereby 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       /     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 n/a

Organization Authorized Signature: Date:     


Print Name:       Phone No.       Fax No.:     
Title:       E-mail:      
For Customer use only (If Applicable)
Part Warrant Disposition : Approved Rejected Other      

Customer Signature: Date:      


Print Name:       Customer Tracking Number (optional)      
March 2006 CFG-1001

ã www.ringwald-sasbach.de // Ihre Firma GmbH / Kundenstraße 1 / www.ihre-firma.de

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