(Sieger)_TIP_230831_dj_(PPAP Fermapor HF-A-45D01-N-FR)

Part Submission Warrant
Part Name Fermapor HF-A-45D01-N-FR Cust. Part Number N/A
Shown on Drawing No. N/A Org. Part Number IDH: 2930554
Engineering Change Level N/A Dated N/A
Additional Engineering Changes N/A Dated N/A

Safety and/or Government Regulation Yes No Purchase Order No. N/A Weight (kg) 1000
Checking Aid No. N/A Checking Aid Engineering Change Level N/A Dated
ORGANIZATION MANUFACTURING INFORMATION CUSTOMER SUBMITTAL INFORMATION

Henkel AG & Co. KGaA, Location Düsseldorf Perfect Sales Electronics Pvt. Ltd
Supplier Name & Supplier Code Customer Name/Division
Henkelstraße 67 Buyer/Buyer Code
Street Address
Düsseldorf Germany 40589 Application
City State Postal Code
MATERIALS REPORTING
Has customer-required Substances of Concern information been reported? YES NO n/a
Submitted by IMDS or other customer format: IMDS-ID number: Creation if required
Are polymeric parts identified with appropriate ISO marking codes? YES NO n/a
REASON FOR SUBMISSION

Initial Submission Change to Optional Construction or Material
Engineering Change(s) Sub-Supplier or Material Source Change
Tooling: Transfer, Replacement, Refurbishment or additional Change in Part Processing
Correction of Discrepancy Part Produced at Additional Location
Tooling Inactive > 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 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 batch production, batch number: 2631544373
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 N/A / hours.
I also certify that documented evidence of such compliance is on file and available for your review. I have noted any deviations from this declaration below.
EXPLANATION/COMMENTS: This PSW will be deemed as accepted and approved by the customer if a dispositioned and signed
copy of this document is not returned to Henkel (e-mail below) within one month of the date below.
Is each Customer Tool Properly tagged and numbered? YES NO n/a
Organization Authorized Signature Date 02.10.2023

Print Name Mr. Detlev Jeron Phone No. +49(0)211/797-5254 Fax No.
Title Quality Manager E-mail detlev.jeron@henkel.com
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
Production Part Approval
Material Test Results
ORGANIZATION: Henkel AG & Co. KGaA, Location Düsseldorf PART NUMBER: IDH: 2930554
SUPPLIER/VENDOR CODE: PART NAME: Fermapor HF-A-45D01-N-FR
MATERIAL SUPPLIER: DESIGN RECORD CHANGE 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: Henkel AG & Co. KGaA
SPECIFICATION / TEST QTY. NOT
MATERIAL SPEC. NO. / REV / DATE LIMITS DATE TESTED SUPPLIER TEST RESULTS (DATA) OK OK
Fermapor HF-A-45D01-N-FR
batch number: 2631544373
Viscosity Brookfield 1800 3200 2150 mPas 
Colour non-crosslinked Beige beige 
Mixture of A- and B-component

mixing ration 1,3 : 1,0 with Fermadur B-N
(cone 10g)
Pot life SQS 150 400 259 sec. 
Tack-free time SQS 8.0 25.0 12.0 min 
Hardness Shore D 40 55 42 Sh D 
Density SQS 0.45 0.57 0.53 g/cm³ 
water content 1000 1500 1250 ppm 
Colour crosslinked Beige beige 
Blanket statements of conformance are unacceptable for any test results.
MARCH CFG-1004 SIGNATURE TITLE DATE

2006 Quality Manager 02.10.2023

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Available Formats

Part Submission Warrant

Part Name Fermapor HF-A-45D01-N-FR Cust. Part Number N/A

Shown on Drawing No. N/A Org. Part Number IDH: 2930554

Engineering Change Level N/A Dated N/A

Additional Engineering Changes N/A Dated N/A

ORGANIZATION MANUFACTURING INFORMATION CUSTOMER SUBMITTAL INFORMATION

REASON FOR SUBMISSION

REQUESTED SUBMISSION LEVEL (Check one)

Organization Authorized Signature Date 02.10.2023

Customer Signature Date

Mixture of A- and B-component

Blanket statements of conformance are unacceptable for any test results.

MARCH CFG-1004 SIGNATURE TITLE DATE

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