零件提交保证书
市 City
省 Region
生产厂家 Organization Name & Supplier/Vendor Code 宋严王村博宏工业区G 幢4#-1楼
4#-1,Building G, Bohong Industrial Part,Songyanwang 街道地址 Street Address
工程变更等级 Engineering Change Level 其它工程变更 Additional Engineering Changes 客户名称 Customer Name/Division
采购员 Buyer/Buyer Code 生产信息
ORGANIZATION MANUFACTURING INFORMATION
日期 Dated 重量 Weight (kg)日期 Dated 检具变更号 Checking Aid Engineering Change Level
安全/政府法规 Safety and Government Regulation 订单号 Order No.
要求的提交等级（选择一项）REQUESTED SUBMISSION LEVEL (Check one)
材质报告
MATERIALS REPORTING
宁波艾尔欧伊机械有限公司 Ningbo LH Lift Oy Machinery Ltd. Co.
用过IMDS 或客户要求的其它形式提交报告： Submitted by IMDS or other customer format:
塑料件是否已标注相应的ISO 编码？Are polymeric parts identified with appropriate ISO marking codes?提交结果 SUBMISSION RESULTS 提交结果为：The results for
日期 Dated
中国 P.R.C 质量工程师 Quality Engineer 客户信息
CUSTOMER SUBMITTAL INFORMATION
检具编号 Checking Aid No.
零件提交保证书 Part Submission Warrant (PSW)
产品名称 Part Name 图纸编号 Drawing No.
客户零件号 Cust. Part Number 原始零件号 Org Part Number
这些结果满足所有设计记录要求：These results meet all drawing and specification requirements: 客户要求的受关注物质的信息是否已报告？ Has customer-required Substances of Concern information been reported?提交原因（至少选择一项）REASON FOR SUBMISSION (Check at least one)
如果选择 ”否“应解释 If "NO" - Explanation Required
邮编 Postal Code
国家 Country
浙江Zhejiang 宁波 Ningbo 315177传真 Fax No.
模具/型腔/生产工艺 Mold / Cavity / Production Process 声明 DECLARATION
我声明，本次提交所使用的样品是出自我们生产过程的，具有代表性的零件，且已经符合生产件批准程序的所有要求：我进一步保证这些样品是以 件 / 个小时的生产速率制造的。同时我保证所有符合性证明文件都已经归档妥当，以供评审。我还说明了任何与此声明有偏差的内容，
I claim these samples are came from our normal process, they can be representational all parts. All processes are met the PPAP requirement. I claim these the produce speed for these sample are ____ pcs/____hours. All the documents has been kept. If necessary, please review. If there is difference between the claim, please see detail in following blank area.说明：EXPLANATION/COMMENTS:
日期 Date
仅供客户使用（如适用）FOR CUSTOMER USE ONLY (IF APPLICABLE)
每种顾客的工具是否都已经适当的加标签和编号？Is each Customer Tool properly tagged and numbered?
授权的供方代表签名 Organization Authorized Signature 日期 Date
印刷体姓名 Print Name 电话 Phone No.印刷体姓名 Print Name 客户跟踪号码（可选的） Customer Tracking Number (optional)
职位 Title 邮箱 E-mail
保证书批准意见Part Warrant Disposition 客户签名 Customer Signature
Yes
No
No
n/a
首次提交 Initial Submission 工装转移/替代/维修/附加Tooling:Transfer,Replacement,Refurbishment,additional 工装停用1年以上 Tooling Inactive > than 1 year
更改可选用的结构或材料 Change to Optional Construction or Material 工程变更 Engineering Change(s)
误差校正 Correction of Discrepancy
供应商或材料来源改变 Supplier or Material Source Change 零件加工过程更改 Change in Part Processing
其它原因，请在下方注明 Other - please specify below
产品在其它地方量产 Parts Produced at Additional Location 1:只向顾客提交保证书(若指定为外观项目，应该递交外观批准报告) Level 1: Warrant only(and for designated appearance items, an Appearance Approval Report) submitted to customer. 4.保证书及顾客规定的其他要求 Level 4 - Warrant and other requirements as defined by customer.
2.向顾客提交零件保证书及产品样品及有限支持数据 Level 2 - Warrant with product samples and limited supporting data submitted to customer.
3.向顾客处递交保证书及产品样品及全部支持数据 Level 3 - Warrant with product samples and complete supporting data submitted to customer. 5.供应商处的保证书及产品样品及全部支持数据 Level 5 - Warrant with product samples and complete supporting data reviewed at organization's manufacturing location.Yes
材质和性能 material and functional tests
外观 appearance criteria
统计过程数据 statistical process package
Yes
No
Yes No n/a
批准 Approved
拒收 Rejected
其余 Other
Yes No n/a
尺寸 dimensional measurements