Part Submission Warrant

Part Submission Warrant (PSW)

Report no. supplier
 

Part name
 
Part no. customer
 

Drawing no. customer
 
Part no. supplier
 

Engineering drawing change level
 
Issue date
 

Additional engineering changes
 
Issue date
 

Safety and/or government regulation

Yes

No
Weight
 

Supplier Manufacturing Information
Customer information

 

 

Supplier name and identification no. Order no. customer

 

 

Street, Address

Buyer

 

 

ZIP / City / State

Application customer / Final customer

   

Production site Customer site

Note:
Does this part contain one or more restricted or reportable substances?

Yes

No

IMDS no. (or customer guideline QAA Part 2 Appendix 4):
 

Are plastic parts identified with appropriate ISO marking codes?

Yes

No

Not applicable

Reason for submission


Initial submission

Change to optional construction or material


Engineering change(s)

Change of sub-supplier or material source


Tooling: transfer, replacement, refurbishment, or add.

Change in part processing


Correction of discrepancy

Parts produced at other/additional location


Production / Tooling inactive more than 1 year

Others – please specify on separate page

Requested submission level


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 during APQP by customer


Level 5 – Warrant with product samples and