PLASTIC IT FCG S.A. DE C.V.
Part Submission Warrant
Part Name: Camouflage LH Cust. Part Number: 5C3 868 043
Shown on Drawing No: N/A Org. Part Number: 5C3 868 043
Engineering Change Level: N/A Date: N/A
Additional Engineering Changes: N/A Date: N/A
Safety and/orGovernment Regulations: Yes No Purchase Order No Weight (kg): 0.036
Checking Aid No: N/A Checking Aid Engineering Change Level: N/A Dated: N/A
ORGANIZATION MANUFACTURING INFORMATION CUSTOMER SUBMITTAL INFORMATION
PLASTIC IT FCG SA DE CV (4600005774) Inject Tech
Organization Name & Supplier/Vendor Code Customer Name/Division
Camino a San lorenzo 808-A Parque Industrial Sanctorum Ruben Espinoza
Street Address Buyer / Buyer Code
Cuautlancingo Puebla 72730 México VW
City Region Postal Code Country Application
MATERIALS REPORTING
Has customer-required Substances of Concern information been reported? Yes No n/a
Submitted by IMDS or other customer format?
Are polymetric parts identified with appropriate ISO marking codes? Yes No n/a
REASON FOR SUBMISSION (Check at least one)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) 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 below
PSW update
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 performance / 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 PEG-01/ 2 /Injection Molding
DECLARATION
I hereby 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 __872__ / _8__hours.
I also certify that documented evidence of such compliance is on file and available for review. I have noted any deviations from this declaration below.
EXPLANATION / COMMENTS: El Cliente realiza y proporciona los análisis de índice de fluidez, los reportes dimensionales, así como el reporte de flamabilidad.
Is each Customer Tool properly tagged and numbered? Yes No n/a
Organization Authorized Signature Date 11/26/2013
Print Name Elmer Vázquez Phone No (222) 2 10 54 00 Fax No. N/A
Title Operaciones E-mail elmer.vazquez@plasticit.com.mx
FOR CUSTOMER USE ONLY (IF APPLICAPLE)
Part Warrant Disposition: Approved Rejected Other: (If not approved, specify reason)
Customer Signature Date:
Print Name Customer Tracking Number (optional)
Form # FCD-0024: Revision 3
Fabrica de Papel S.A. DE C.V. Certificado de Emision de una Parte
Part Name: Mezcla Cust. Part Number: 5C3 868 044
Shown on Drawing No: N/A Org. Part Number: 5C3 868 044
Engineering Change Level: N/A Date: N/A
Additional Engineering Changes: N/A Date: N/A
Safety and/orGovernment Regulations: Yes No Purchase Order No Weight (kg): 0.036
Checking Aid No: N/A Checking Aid Engineering Change Level: N/A Dated: N/A
ORGANIZATION MANUFACTURING INFORMATION CUSTOMER SUBMITTAL INFORMATION
Fabrica de Papel SA DE CV (4600005774) Papeleria ABC
Organization Name & Supplier/Vendor Code Customer Name/Division
Camino a San lorenzo 808-A Parque Industrial Lerma Eduardo Mercado
Street Address Buyer / Buyer Code
Toluca Lerma 72730 México VW
City Region Postal Code Country Application
MATERIALS REPORTING
Has customer-required Substances of Concern information been reported? Yes No n/a
Submitted by IMDS or other customer format?
Are polymetric parts identified with appropriate ISO marking codes? Yes No n/a
REASON FOR SUBMISSION (Check at least one)
Initial Submission Change to Optional Construction or Material
Engineering Change(s) 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 below
PSW update
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 performance / 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 PEG-01/ 2 /Injection Molding
DECLARATION
I hereby 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 __872__ / _8__hours.
I also certify that documented evidence of such compliance is on file and available for review. I have noted any deviations from this declaration below.
EXPLANATION / COMMENTS: El Cliente realiza y proporciona los análisis de índice de fluidez, los reportes dimensionales, así como el reporte de flamabilidad.
Is each Customer Tool properly tagged and numbered? Yes No n/a
Organization Authorized Signature Veronica Valeria Quintanilla Hernandez Date 11/26/2022
Print Name Valeria Quintanilla Phone No 722 790 5577 Fax No. N/A
Title Ing. Procesos E-mail valeriaquintanilla83@gmail.com
FOR CUSTOMER USE ONLY (IF APPLICAPLE)
Part Warrant Disposition: Approved Rejected Other: (If not approved, specify reason)
Customer Signature Eduardo Mercado Rodriguez Date: ###
Print Name Eduardo Mercado Customer Tracking Number (optional)
Form # FCD-0024: Revision 3
