Part Submission Warrant Attachment E1 - SMP …

1 Attachment E1:July 1999 CFG-1001F-QA-09-001 issue 1 The original copy of this document shall remain at the supplier' locationwhile the part is active (see Glossary).Optional: customer trackingnumber: # _____Part Submission WarrantPart NamePart NumberDatedAdditional Engineering ChangesDatedShown on Drawing NumberPurchase Order (kg)Checking Aid NumberEngineering Change LevelDatedSUPPLIER MANUFACTURING INFORMATIONSUBMISSION INFORMATIONS upplier Name Customer Name/DivisionStreet AddressBuyer/Buyer CodeCityStateZipApplicationNote:Does this part contain any restricted or reportable substances?Are plastic parts identified with appropriate ISO marking codes?REASON FOR SUBMISSIONI nitial submissionChange to Optional Construction or MaterialEngineering Change(s)Sub-Supplier or Material Source ChangeTooling.

2 Transfer, Replacement, Refurbishment, or additionalChange in part ProcessingCorrection of DiscrepancyParts produced at Additional LocationTooling Inactive > than 1 yearOther - please specifyREQUESTED Submission LEVEL (Check one)Level 1 - Warrant only (and for designated appearance items, an Appearance Approval Report) submitted to 2 - Warrant with product samples and limited supporting data submitted to 3 - Warrant with product samples and complete supporting data submitted to 4 - Warrant and other requirements as defined by 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing RESULTSThe results for dimensional measurements material and functional tests appearance criteria statistical process packageThese results meet all drawing and specification requirements.

3 (If "NO" - Explanation Required)Mold / Cavity / Production ProcessDECLARATIONI affirm that the samples represented by this Warrant are representative of our parts, have been made to the applicableProduction part Approval Process Manual 3rd Edition Requirements. I further Warrant these samples wereproduced at the production rate of _____ / 8 hours. I have noted any deviations from this declaration :Print NameTitle#REF!Fax Authorized SignatureDateFOR CUSTOMER USE ONLY (IF APPLICABLE) part Warrant Disposition: part Functional Approval:Customer NameCustomer SignatureDateSafety and/or Government RegulationEngineering Drawing Change LevelPhone Materials/Function Appearance YES NO Yes No Yes No Yes No Approved Rejected Other Approved Waived