For Ease of Use with the forms, you could enter all relevant information here and then

avoid having to retype it.

2 3 4 5 6 7 8 9
Part Number Cust Part No Part Name Drawing Num Rev Level Rev Date Part Weight (kg) Application Org Name
Enter Your Part Numbe Enter Customer ParPart DescripDrg Number Enter Rev L Enter Rev Enter Weight What VehiclesYour Comp
nd then avoid having to retype it.

10 11 12 13 14 15 16 17 18 19 20 21
Org Street Ad City Region Country Zip Supplier Code Auth. Rep Ph Number Fax Number Customer Na Buyer Buyer Code
Company StreCity State Country ZIP Your Supplier C Name of th Contact Ph Contact Fax Name of the Enter Y Buyer Code
 22
Lab/Insp Facility
Lab/Insp Facility
 APPEARANCE APPROVAL REPORT
PART DRAWING APPLICATION
Enter Your Part Number Drg Number Enter Rev Date
NUMBER NUMBER (VEHICLES)
PART BUYER E/C LEVEL DATE
Part Description Buyer Code Drg Number
NAME CODE
SUPPLIER MANUFACTURING Company Street Address City State Country SUPPLIER
Your Company Name Your Supplier Code
NAME LOCATION ZIP CODE
REASON FOR PART SUBMISSION WARRANT SPECIAL SAMPLE RE-SUBMISSION OTHER
SUBMISSION PRE TEXTURE FIRST PRODUCTION SHIPMENT ENGINEERING CHANGE

APPEARANCE EVALUATION

Organization Sourcing & Texture Information Authorized Customer

Pre-Texture Evaluation
Representative Signature & Date

Correct & Proceed

Correct & Resubmit

Approved to Texture

COLOR EVALUATION
COLO
COLOR
R MASTER MASTER MATERIAL MATERIAL METALLIC PART
TRISTIMULUS DATA HUE VALUE CHROMA GLOSS SHIPPIN
SUFFI NUMBER DATE TYPE SOURCE BRILLIANCE DISPOSITION
G SUFFIX
X
DL* Da* Db* DE* CMC RED YEL GRN BLU LIGHT DARK GRAY CLEAN HIGH LOW HIGH LOW

COMMENTS

SUPPLIER Enter Weight PHONE NUMBER DATE AUTHORIZED CUSTOMER DATE

REPRESENTATIVE SIGNATURE
SIGNATURE
March 2006 CFG-1002
 Production Part Approval
PERFORMANCE TEST RESULTS
Organization: Your Company Name Part Number: Enter Your Part Number
Supplier/Vendor Code: Your Supplier Code Part Name: Part Description
Name of Laboratory: Your Supplier Code Design Record Level Change: Enter Rev Level
*Customer Specified Supplier/Vendor Code: Engineering Change Documents:

* If source approval is req'd, include the Supplier (Source) & Customer assigned code.

Specification / Qty. Not

Test Specification / Rev / Date Test Date Supplier Test Results (Data) / Test Conditions Ok
Limits Tested Ok

March 2006 CFG-1005 Blanket statements of conformance are unacceptable for any test results.
SIGNATURE TITLE DATE
 Production Part Approval
MATERIAL TEST RESULTS
Organization: Your Company Name Part Number: Enter Your Part Number
Supplier/Vendor Code: Your Supplier Code Part Name: Part Description
Material Supplier: Design Record Change Level: Enter Rev Level
*Customer Specified Supplier/Vendor Code: Engineering Change Documents:

* If source approval is req'd, include the Supplier (Source) & Customer assigned code. Name of Laboratory: Your Supplier Code
Qty. Not
Material Specification Specification Limits Test Date Test Results Ok
Tested Ok

March 2006 CFG-1004 Blanket statements of conformance are unacceptable for any test results.
SIGNATURE TITLE DATE
 Production Part Approval
DIMENSIONAL TEST RESULTS
Organization: Your Company Name Part Number: Enter Your Part Number
Supplier/Vendor Code: Your Supplier Code Part Name: Part Description
INSPECTION FACILITY: Design Record Change Level: Enter Rev Level
Engineering Change Documents:
Lab/Insp Facility Used

Specification / Qty. Not

Item Dimension/Specification Test Date Organization Measurement Results (Data) Ok
Limits Tested Ok

X
X

X
X

X
X

X
X

X
X

X
X

X
X

X
X

X
March 2006 CFG-1003 Blanket statements of conformance are unacceptable for any test results.
SIGNATURE TITLE DATE
 Part Submission Warrant
Part Name Part Description Customer Part Number Enter Customer Part #
Shown on Drawing No. Drg Number Organization Part # Enter Your Part Number
Engineering Change Level Enter Rev Level Dated Enter Rev Date
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

Your Company Name Name of the Customer

Organization Name & Supplier/Vendor Code Customer Name/Division

Company Street Address Enter Your Buyer's Name

Street Address Buyer/Buyer Code

City State ZIP Country What Vehicles is this used on?

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
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 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 drawing and specification requirements: Yes NO (If "NO" - Explanation Required)
Mold / Cavity / Production Process
DECLARATION
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