PART SUBMISSION WARRANT Delivered Part Part Specifications PART MANUFACTURING INFORMATION Part Name Part Number Safety and/or Government Regulation YES NO Drawing Change Level Additional Changes Drawing Number Engineering Change# SUPPLIER MANUFACTURING INFORMATION Supplier Name Supplier Code Address City State Zip Code SUBMISSION INFORMATION Dimensional Material/Functional Appearance Customer Buyer REASON FOR SUBMISSION Please Select Reason: REQUESTED SUBMISSION LEVEL (Check one) Submission Level: SUBMISSION RESULTS Dimensional measurements Material and functional tests Appearance Criteria Statistical Process Package These results meet all drawing and specification requirements: YES NO Declaration I hereby affirm that the samples represented by this warrant are representative of our parts, have been made to the applicable Production Approval Process Manual 3rd Edition. I have noted any deviations from this declaration below. Requirements: I further warrant these samples were produced at the production rate of: /8 hours EXPLANATION / COMMENTS (may not demonstrate the production Run-at- Rate capacity) Print Name Title Phone Number Fax Number Date Supplier Authorized Signature FOR CUSTOMER USE ONLY Part warrant disposition: Approved Rejected Part Functional Approval: Approved Rejected Customer Name Date Customer Signature Specified Measured A: Width = 15.83 +/- 0.03 in B: Axle Bore Dia = 3.94 +/- 0.01 in C: Driveshaft Bore Dia = 3.93 +/- 0.01 in D: E: F: G: H: