| INSTITUTO TECNOLOGICO DE SALTILLO REQUERIMIENTOS DE LA IND. AUTOMOTRIZ Fecha: Num.

Revision: 1 Fecha Ultima Rev:

INGENIERIA INDUSTRIAL Item/Componente: Vehiculo: Ao Modelo: Miembros del Equipo:

PACKAGING CONTAINER QUALIFICATION FORM

CONCEPT
Program: Model Year: Part #: Part Description: Mfg. Site: SOP Date: Packaging Engineer: Top View of Container / Side View of Rack Balance Out:

PROTOTYPE PRODUCTION X Revision Level: GENERAL INFORMATION

Volume of product: IQP Customer: IN-transit to customer: IN-transit from customer: Contingency / other: TOTAL SYSTEM DAYS:

Date: SYSTEM DAYS 10 0 0 0 0 10

1-Nov-11

Container Information
Container Type: Dunnage Type: Outside Dimensions: Totes Per Pallet Gross Weight: Parts per Container: Color: Parts Sequenced?: Stackable?: Container ID/MEQ #: Label Holder Description: Owner: Quantity Purchased: Packaging Supplier: NA

Foto del Empaque

SHIPPING INFORMATION
Ship From Locations: Ship To Locations: Pallet load size: Return Ratio:

EXPENDABLE BACK UP INFORMATION Description Part # Quote/PO# Supplier

Trailer Assumptions: Containers/Trailer:

DOCUMENTED APPROVAL FROM THE CUSTOMER MUST BE OBTAINED BEFORE SHIPPING IN EXPENDABLE PACKAGING. SERVICE PACKAGING Part # Quote/PO#

Description CONTAINER LOADING INSTRUCTIONS

Supplier

CLEANING INSTRUCTIONS & COMMENTS

Amount Allocated: Cleaning Supplier: Frequency:

Customer: JCI Ergonomics Eng:

$0

PACKAGING APPROVAL
Date: Date: JCI Manufacturing Engineer: JCI QualityEngineer: JCI Packaging Engineer:

Date:

Date: Date: Date:

Part Submission Warrant

Part Name Safety and/or Government Regulation Additional Engineering Changes Shown on Drawing Number Checking Aid Number SUPPLIER MANUFACTURING INFORMATION Purchase Order No. Engineering Change Level SUBMISSION INFORMATION Part Number Engineering Drawing Change Level

Yes

No

Dated Dated Weight (kg) Dated

Dimensional
Supplier Name Customer Name/Division Street Address Buyer/Buyer Code City Note: State Zip Application

Materials/Function

Appearance

Does this part contain any restricted or reportable substances? Are plastic parts identified with appropriate ISO marking codes?

Yes
Yes

No
No

REASON FOR SUBMISSION Initial submission Engineering Change(s) Tooling: Transfer, Replacement, Refurbishment, or additional Correction of Discrepancy Tooling Inactive > than 1 year 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 These results meet all drawing and specification requirements: Mold / Cavity / Production Process DECLARATION I affirm that the samples represented by this warrant are representative of our parts, have been made to the applicable Production Part Approval Process Manual 3rd Edition Requirements. I further warrant these samples were produced at the production rate of EXPLANATION/COMMENTS: Print Name Supplier Authorized Signature FOR CUSTOMER USE ONLY (IF APPLICABLE) Part Warrant Disposition: Title Phone No. Date Fax No. / 8 hours. I have noted any deviations from this declaration below. material and functional tests YES appearance criteria statistical process package NO (If "NO" - Explanation Required) Change to Optional Construction or Material Sub-Supplier or Material Source Change Change in Part Processing Parts produced at Additional Location Other

Approved Other

Rejected

Part Functional Approval:

Approved Waived
Date

Customer Name

Customer Signature

Rev. 0
75991530.xls.ms_office Optional: customer tracking number: # ______________

July 1999

CFG-1001

The original copy of this document shall remain at the supplier' location while the part is active (see Glossary).