零件提交保证书
Part Submission Warrant
零件名称 Part Name
零件编号 Part Number
日期 Dated 重量 Weight
后缀 Suffix
图纸编号.
Shown on Drawing No. 应用项目
Application/Project 检具编号
Checking Aid No.
工程设计记录更改等级
Engineering Design Record Change Level
检具工程更改等级
Checking Add Eng. Change Level 订单号
Purchase Order No.
kg
日期
Dated 采购员
Buyer
顾客名称/部门
Customer Name/ Division
供应商制造信息SUPPLIER MANUFACTURING INFORMATION
供应商名称 Supplier Name 供应商地址 Street Address
象山申达轿车配件厂 象山汤家店工业区
供应商代码 Supplier Number
邮政编码 Z-Code
023
提交类型：
手工样件
工装样件
其它，
SUBMISSION TYPE :
REASON FOR SUBMISSION
首次提交 Initial Submission 工程更改
Engineering Change(s)
偏差纠正
Correction of Discrepancy 其它，
Additional Quantities
仅外观更改（产品尺寸已认可） Color Change Only
(Dimensionally Production Approved)
提交要求（选择一项）
SUBMISSION REQUIREMENTS (Check one)
等级1 Level 1 等级2 Level 2 等级3 Level 3
零件直接运至指定接收地点。保证书直接送到采购部门指定的地点。
Parts shipped directly to designated Receiving Location. Warrant directed to location designated by the procuring division.
零件直接运至指定接收地点。全套交样文件直接送到采购部门指定的地点。
Parts shipped directly to designated Receiving Location. Complete documentation directed to location designated by the Procuring Division.
零件直接运至指定接收地点。全套交样文件和相关检具直接送到采购部门指定的地点。
Parts shipped directly to designated Receiving Location. Complete documentation and checking fixtures directed to location designated by the Procuring Division.
提交信息 如第1、2、3、4、5项提问回答为“否”，则需提交整改计划。
SUBMISSION INFORMATION
1. 零件是否满足工程设计记录中的尺寸要求？
Does Part meet dimensional requirements on the design record? 2. 零件是否满足工程设计记录中的功能要求？
Does Part meet functional requirements on the design record? 3. 零件是否使用指定材料生产？
Was Part produced with specified materials? 4. 零件是否满足SOR 设计认证要求？
Does the Part meet the Design Validation requirements per SOR? 5. 零件是否满足SOR 产品认证要求？
Does the Part meet the Product Validation requirements per SOR? 6. 是否附带检测结果？
Are inspection results enclosed? 7. 是否附带设计记录
Is the Design Record enclosed? 8. 零件关键尺寸特性是否确定？
Have Part KPC's been identified? 9. 使用何种检验流程来检验零件？
What was the Checking Process used to check Part? 10. 检验流程是否经过采购部门确认？
Was the Checking Process defined by the Procuring Division? 11. 是否随零件发运检具？
Is Checking Fixture included with shipment?
是
货运单号：
Serial Numbers for this shipment:
在此处对回答“否”的问题进行解释或注释： Explanation of "NO" answer or comment here:
供应商姓名（请打印） Supplier Name (please print) 供应商签字
Supplier Authorized Signature
王月明
职务 Title
技术厂长
电话号码. Phone No.
日期 Dated:
0574-65623755
仅供顾客使用
Applied for Customer Only
零件提交认可（同意装配）：批准拒绝其它，
顾客签字： 日期 Customer’零件功能认可（试验通过）：批准拒绝其它，
顾客签字： 日期 Customer’
CORRECTIVE ACTION PLAN
整改计划
零 件 编 号：
Part Number
后缀
Suffix
零件不合格说明：
NONCONFORMANCE DESCRIPTION:
疑似不合格零件的数量：
Quantity Suspected with Nonconformance:
应急措施：
IMMEDIATE FIX:
根本原因：是什么原因导致零件不合格？
ROOT CAUSE: What is causing the nonconformance?
整改措施：采取哪些措施保证不再出现此类不合格零件？
CORRECTIVE ACTION: What steps will be taken to assure that this nonconformance will not reoccur?
零件更改保证日期：
Corrected Part promise date: 进度跟踪日期：
Midpoint progress date:
该零件可否用于样件？
Is this Part usable for prototype?
供应商工程师（请打印）：
Supplier Engineer Name (Please print): 供应商负责人签字：
Supplier Authorized Signature
SAGW 工程师（请打印）：
SAGW Engineer Name (Please print): SAGW 负责人签字：
SAGW Authorized Signature:
电话号码： Phone No.
日期： Dated:
电话号码
Phone No. 日期： Date:
编号： Code: