This document is a project submission form for a part called a PCB support with part number 9770.12-030. It provides information on the customer, submission reason, supplier comments and declaration, and submission results. The supplier affirms that the samples are representative of normal production and meet customer specifications, with any deviations noted in comments. The submission results are to meet all drawing, specification and qualification requirements.

1. 2015/3/14
9770.12-030
Project: f
Tool / Cavity #: 2015/10/14
Name:
Address:
City:
Province:
Postal Code:
Country:
NO
V
Previously
Submitted
Submission
Required
Change to Optional Material
Change in Part Processing
Date:
Date:
Full Comments:
Restricted
Rejected
Customer:
Qualification Status
-------------------------------------------- For Customer Use Only -------------------------------------------------
Part Disposition: Customer:
Submission Reason Submitted
Initial Submission
Engineering Change(s)
Tooling:Transfer, Replacement,
Refurbishment, or additional
Correction of Discrepancy
Sub-Supplier, Manufacturing or Material
Source Change
Supplier Comments
Declaration:
1. Supplier affirms that the samples represented by this warrant are representative
of normal production and process capabilities. Supplier also affirms parts have been
made to the applicable customer drawings and specifications and are made to the
applicable customer drawings and specifications and are made from specified
materials on regular production tooling with no operations other than the regular
production process.
2. Parts meet Customer Cosmetic Specification Requirements where applicable.
3.Any deviations have been noted in the comment area below.
Submission Results: Meet All Drawing,
Specification and Qualification Requirements:
No (Remarks in Supplier
Minime coffee machine Revision / ECN:
T2(1-4) Revision Date:
Supplier Information and Declaration
Submitted By:
Reviewed By:
Part Submission Warrant
Submission Revision Number: 9770.12-030 Submisison Date:
Part Description: PCB support Part Number:
----------Process Definition Documents----------
-------------------Capability Study-----------------
-----------------------Sample------------------------
-----------Dimensional Evaluation (FAI)----------
-----------------------GR&R-------------------------
-------------------Process Flow---------------------
------------Process Work Instructions------------
------------Process Management Plan------------
------------------Process FMEA--------------------
---------------Other (Define Below)---------------
DGQAI-020-F3.01