HH Cap-PSW

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Part Submission Warrant

Part Name HYDRAULIC HEAD CAP Part Number 28458924


Safety and/or
Government Regulation Yes No Engineering Drawing Change Level 004 Dated 13.10.2015

Additional Engineering Changes ---- Dated ----

Shown on Drawing No. 28458924 Purchase Order No. Weight(Kg) 0.0242 kg

Checking Aid No. SPT/DT/CA/HH-00 Engineering Change Level ---- Dated -----

SUPPLIER MANUFACTURING INFORMATION CUSTOMER SUBMITTAL INFORMATION

SUPREME PRESSTECH DELPHI TVS TECHNOLOGIES


Supplier Name & Supplier Code Customer Name / Division

SUPREME PRESSTECH Mr. Rajkumar


Street Address Buyer / Buyer Code
56/3, KAMMASANDRA AGRAHARA VILLAGE, KASABA HOBLI,
ANEKAL TALUK, BANGALORE DT 562106 AUTOMOTIVE PARTS
City State Zip Country Application
MATERIALS REPORTING
Yes No N/A
Does this part contain any restricted or reportable substances?
Submitted by IMDS or other customer format: IMDS ID / Version : Creation Date :

IMDS Accpected Date : Supplier IMDS ID :

Are plastic parts identified with appropriate ISO marking codes? Yes No N/A

REASON FOR SUBMISSION (Check at list one)


Initial Submission Change to Optional Construction or Material
Engineering Changes(s) Sub-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

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 supplier'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 PRESSING & MACHINING

DECLARATION
I hereby affirm that the samples represented by this warrant are representative of our parts and have been made to the applicable Production
Part Approval Process Manual 4th Edition Requirements. I further warrant these samples were
produced at the production rate of 200 / 8 hours
hours. I have noted any deviations from this declaration below:

EXPLANATION / COMMENTS:

Supplier Authorized Signature Date 17.07.2022


Print Name Manoharan R Phone No. 9698712440 Fax No.
Title Manager-Quality E-mail supreme_presstech@rediffmail.com
FOR CUSTOMER USE ONLY (IF APPLICABLE)
Part Warrant Disposition: Approved Rejected Other Part Functional Approval : Approved

Waived
Customer Signature Date

Print Name Customer Tracking Number (Optional)

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