This certificate of conformity document certifies that a supplier has delivered products according to a contract. It lists the supplier and acquirer details, contract and shipment information, and provides statements that the products conform to the contract requirements with the exceptions of any concessions noted. The supplier representative signs and dates the document to verify the quality certification.

1. PCE/00038
ANNEX D
Certificate of ConformityC
Certificate of Conformity
1. Supplier CoC Serial No.
2. Supplier Name and Address: 3. Contract Number:
PCE/00038
4. Contract Modification Number:
5. Details of Concessions:
6. Acquirer Name and Address: 7. Deliver Address:
8. Contract
item number
9. Product Description and/or part number 10. Quantity 11. Shipment Document
Numbers
12. Undelivered
Quantity
13.
N/A
Traceability Information reference DEFCON 627 (check the N/A box to indicate no traceability requirements)
a. Sub-contract/Order number:
b. Specification/Drawing number including issue:
c. Identification Marks and/or serial number(s):
d. Material Cast number:
e. Batch and/or Lot number:
f. Test and/or Inspection Report(s):
g. Incoming Release Note number/Reference:
14. Other Remarks or Comments: (e.g. Cure date. Shelf life.)
15. Supplier Statement of Quality:
It is certified that apart from the concessions noted in block #5 above, the products listed above conform in all respects to the
contract requirements.
Date: Name and Post Title: Signature:
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