Part Submission Warrant

Part Name Cust. Part Number

Shown on Drawing No. Org. Part Number

Engineering Change Level Dated

Additional Engineering Changes Dated

Safety and/or Government Regulation Yes No Purchase Order No. Weight (kg)

Checking Aid No. Checking Aid Engineering Change Level Dated

ORGANIZATION MANUFACTURING INFORMATION CUSTOMER SUBMITTAL INFORMATION

Organisation Name & Supllier/ Vendor Code Customer Name/ Division

Street Address Buyer/ Buyer Code

City Region Postal Code Country Application

MATERIALS REPORTING

Has customer-required Substances of Concern information been reported? Yes No n/a

Submitted by IMDS or other customer format:

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

REASONS 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 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 organization's manufacturing location

SUBMISSION RESULTS

The results for dimensional measurements material and functional tests appearance criteria statistical process package

These results meet all design record requirements: Yes No (If "NO" - Explanation Required)

Mold / Cavity / 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 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 devitions from this declaration below.

EXPLANATION/ COMMENTS:

Is each Customer Tool properly tagged and numbered? Yes No n/a

Organistion Authorized Signature

Print name Phone No. Fax No.

Title E-mail

FOR CUSTOMER USE ONLY (IF APPLICABLE)

PPAP Warrant Disposition: Approved Rejected Other

Customer Signature Date

Print Name Customer Tracking Number (optional)

CGG-1001
March
2006 CGG-1001
 Production Part Approval
Dimensional Test Results Page 2 of 4 Pages

ORGANISATION: PART NUMBER:

SUPPLIER/VENDOR CODE: PART NAME:
INSPECTION FACILITY DESIGN RECORD CHANGE LEVEL:
ENGINEERING CHANGE DOCUMENTS:

SPECIFICATION QTY.
ITEM DIMENSION / SPECIFICATION / TEST TESTE ORGANISATION MEASUREMENT OK NOT
LIMITS DATE D RESULTS (DATA) OK

Blanket statements of conformance are unacceptable for any test results.

March SIGNATURE TITLE DATE

2006
CFG-1003
 Production Part Approval
Material Test Results Page 3 of 4 Pages

ORGANISATION: PART NUMBER:

SUPPLIER/VENDOR CODE: PART NAME:
INSPECTION FACILITY DESIGN RECORD CHANGE LEVEL:
*CUSTOMER SPECIFIED SUPPLIER/VENDOR CODE: ENGINEERING CHANGE DOCUMENTS:
* If source approval is req'd, include Supplier (Source) & Customer assigned code. NAME of LABORATORY:
SPECIFICATION
MATERIAL SPEC.NO. / REV / DATE / TEST QTY. SUPPLIER TEST RESULTS (DATA) OK NOT
LIMITS DATE TESTED OK

Blanket statements of conformance are unacceptable for any test results.

March SIGNATURE TITLE DATE

2006
CFG-1004
 Production Part Approval
Performance Test Results Page 4 of 4 Pages

ORGANISATION: PART NUMBER:

SUPPLIER/VENDOR CODE: PART NAME:
INSPECTION FACILITY DESIGN RECORD CHANGE LEVEL:
*CUSTOMER SPECIFIED SUPPLIER/VENDOR CODE: ENGINEERING CHANGE DOCUMENTS:
* If source approval is req'd, include Supplier (Source) & Customer assigned code.
SPECIFICATION
TEST SPECIFICATION / REV / DATE / TEST QTY. SUPPLIER TEST RESULTS (DATA) OK NOT
LIMITS DATE TESTED TEST CONDITIONS OK

Blanket statements of conformance are unacceptable for any test results.

March SIGNATURE TITLE DATE

2006
CFG-1005