Part Submission Warrant

Part Name Customer Part Number Rev.

If applicable

Engineering Drawing
Tool PO Number Change Level Dated

Additional Engineering Changes Dated

Shown on Drawing Number Purchase Order No. Weight (kg)

Checking Aid Number Engineering Change Level Dated

ORGANIZATION MANUFACTURING INFORMATION SUBMISSION INFORMATION

Organization name and Code Customer Name/Division

Street Address Customer Contact

City State Zip Application

Note: Does this part contain any restricted or reportable substances? Yes No

Are plastic parts identified with appropriate ISO marking codes? Yes No

REASON FOR SUBMISSION (check at least one)

Initial submission Change to Optional Construction or Material
Engineering Change(s) Sub-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

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.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
(check) ✘
Level 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing location.

DECLARATION
I affirm that the samples represented by this warrant are representative of our parts and have been made to the applicable customer
drawings and specifications and are made from specified materials on regular production tooling with no operations other than the regular
production process. I also certify that documented evidence of such compliance is on file and available for review.

EXPLANATION/COMMENTS

List Molds / Cavities / Production Processes

Organization Authorized Signature Date

Print Name Phone No. Fax

Title e-mail

FOR CUSTOMER USE ONLY

PPAP Warrant Disposition: Approved Rejected
Interim Comment:
Approval
Customer Signature Date

Print Name

Volvo PSW 4th Edition PPAP

 Part Submission Warrant
1 2 3
Part Name Customer Part Number Rev.
If applicable

Engineering Drawing
4 5
Tool PO Number Change Level Dated

Additional Engineering Changes 6 Dated

Shown on Drawing Number 7 Purchase Order No. 8 Weight (kg) 9

Checking Aid Number 10 Engineering Change Level 11 Dated

ORGANIZATION MANUFACTURING INFORMATION SUBMISSION INFORMATION

12 14
Organization name and Code Customer Name/Division

13 15
Street Address Customer Contact

16
City State Zip Application

Note: Does this part contain any restricted or reportable substances? Yes No
17
Are plastic parts identified with appropriate ISO marking codes? Yes No

REASON FOR SUBMISSION (check at least one) 18

Initial submission Change to Optional Construction or Material
Engineering Change(s) Sub-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

SUBMISSION LEVEL (Check one) 19

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.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
(check) ✘

Level 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing location.

DECLARATION
I affirm that the samples represented by this warrant are representative of our parts and have been made to the applicable customer
drawings and specifications and are made from specified materials on regular production tooling with no operations other than the regular
production process. I also certify that documented evidence of such compliance is on file and available for review.

EXPLANATION/COMMENTS 20

List Molds / Cavities / Production Processes 21

Organization Authorized Signature 22 Date

Print Name Phone No. Fax

Title e-mail
 FOR CUSTOMER USE ONLY
PPAP Warrant Disposition:
Approved Rejected
Interim Approval Comment:

Customer Signature Date

Print Name
Completion of the Part Submission Warrant

PART INFORMATION
1. Part Name: Engineering released finished end item part name. (See Volvo Part Version Report.)
2. Customer Part Number(s): Engineering released finished end item part number. (Volvo PVR number.)
3. Part Revision Level: if applicable. (Volvo PVR Version.)
4. Tool Purchase Order Number: if applicable.
5. Engineering Drawing Change Level & Approval Date: Show change level and date for submission. (Volvo drawing issue,
and drawing.)
6. Additional Engineering Changes: Include all authorized engineering change documents and approval dates not yet incorpo
drawing but which are incorporated in the part.
7. Shown on Drawing Number: The design record that specifies the customer part number being submitted. (Volvo drawing N
drawing.)
8. Purchase Order Number: Enter this number as found on the purchase order.
9. Part weight: Enter the actual weight in kilograms to four significant places.
10. Checking Aid No: Enter the checking aid number, if one is used for dimensional inspection.
11. Checking Aid's Engineering Change Level and Approval Date.

ORGANIZATION MANUFACTURING INFORMATION

12. Organization Name and Code: Show the code assigned to the manufacturing location on the purchase order. (Supplier Nam
supplier No.)
13. Organization Manufacturing Address: Show the complete address of the location where the product was manufactured.

SUBMISSION INFORMATION
14. Customer Name/ Division: Show the corporate name and division or operations group. (Volvo purchasing company, e.g. Vo
Powertrain, etc.)
15. Contact Name: Enter the name of your customer contact. (Volvo SQA and/or Volvo purchaser.)
16. Application: Enter the model year, vehicle name, or engine, transmission, etc.
17. Check the appropriate box to indicate Substances of Concern (Volvo black list STD 1009,1)/ISO marking reporting.

REASON FOR SUBMISSION

18. Check the appropriate box. Add explanatory details in the "other" section.

REQUESTED SUBMISSION LEVEL

19. Identify the submission level requested by your customer. Check the submission items if a level 4 is requested.
If not otherwise agreed Volvo request level 4. The minimum required mandatory documents are:
6. Process FMEA;
7. Control Plan;
9. Dimensional Results including Marked Drawing;
10. Material, Performance Test Results;
13. Appearance Approval Report (if applicable);
17. Records of Compliance with Volvo Specific Requirements (Review of Technical Specification ,RTS). Mandatory for Volvo
18. Part Submission Warrant (PSW).
All other documents shall be submitted to Volvo upon request.

DECLARATION
20. Explanation/Comments: Provide any explanatory details on the submission results; additional information may be attached
appropriate.
21. Enter the number or code that identifies the specific mold, cavity, and/or production process used to manufacture the sample
22. The responsible supplier official, after verifying that the results show conformance to all customer requirements and that all re
documentation is available shall approve the declaration and provide Title, Phone Number, Email Address, and Fax Numb

FOR CUSTOMER USE ONLY

Leave blank
18. Check the appropriate box. Add explanatory details in the "other" section.

REQUESTED SUBMISSION LEVEL

19. Identify the submission level requested by your customer. Check the submission items if a level 4 is requested.
If not otherwise agreed Volvo request level 4. The minimum required mandatory documents are:
6. Process FMEA;
7. Control Plan;
9. Dimensional Results including Marked Drawing;
10. Material, Performance Test Results;
13. Appearance Approval Report (if applicable);
17. Records of Compliance with Volvo Specific Requirements (Review of Technical Specification ,RTS). Mandatory for Volvo
18. Part Submission Warrant (PSW).
All other documents shall be submitted to Volvo upon request.

DECLARATION
20. Explanation/Comments: Provide any explanatory details on the submission results; additional information may be attached
appropriate.
21. Enter the number or code that identifies the specific mold, cavity, and/or production process used to manufacture the sample
22. The responsible supplier official, after verifying that the results show conformance to all customer requirements and that all re
documentation is available shall approve the declaration and provide Title, Phone Number, Email Address, and Fax Numb

FOR CUSTOMER USE ONLY

Leave blank
. (See Volvo Part Version Report.)
item part number. (Volvo PVR number.)

change level and date for submission. (Volvo drawing issue, see PVR

neering change documents and approval dates not yet incorporated on the

the customer part number being submitted. (Volvo drawing No, see PVR and

urchase order.
cant places.
ed for dimensional inspection.
ate.

e manufacturing location on the purchase order. (Supplier Name and Volvo

dress of the location where the product was manufactured.

sion or operations group. (Volvo purchasing company, e.g. Volvo 3P, Volvo

vo SQA and/or Volvo purchaser.)

nsmission, etc.
ern (Volvo black list STD 1009,1)/ISO marking reporting.

her" section.

Check the submission items if a level 4 is requested.

quired mandatory documents are:

(Review of Technical Specification ,RTS). Mandatory for Volvo Powertrain.

e submission results; additional information may be attached as

y, and/or production process used to manufacture the sample parts.

how conformance to all customer requirements and that all required
ovide Title, Phone Number, Email Address, and Fax Number.
her" section.

Check the submission items if a level 4 is requested.

quired mandatory documents are:

(Review of Technical Specification ,RTS). Mandatory for Volvo Powertrain.

e submission results; additional information may be attached as

y, and/or production process used to manufacture the sample parts.

how conformance to all customer requirements and that all required
ovide Title, Phone Number, Email Address, and Fax Number.
 New 4th Edition PSW Completion Instruction Wording

Appendix A
Completion of the Part Submission Warrant

PART INFORMATION
1. Part Name: Engineering released finished end item part name. (See Volvo Part Version Report.)
2. Customer Part Number(s): Engineering released finished end item part number. (Volvo PVR number.)
3. Part Revision Level: if applicable. (Volvo PVR Version.)
4. Tool Purchase Order Number: if applicable.
5. Engineering Drawing Change Level & Approval Date: Show change level and date for submission. (Volvo
drawing issue, see PVR and drawing.)
6. Additional Engineering Changes: Include all authorized engineering change documents and approval
dates not yet incorporated on the drawing but which are incorporated in the part.
7. Shown on Drawing Number: The design record that specifies the customer part number being submitted.
(Volvo drawing No, see PVR and drawing.)
8. Purchase Order Number: Enter this number as found on the purchase order.
9. Part weight: Enter the actual weight in kilograms to four significant places.
10. Checking Aid No: Enter the checking aid number, if one is used for dimensional inspection.
11. Checking Aid's Engineering Change Level and Approval Date.

ORGANIZATION MANUFACTURING INFORMATION

12. Organization Name and Code: Show the code assigned to the manufacturing location on the purchase
order. (Supplier Name and Volvo supplier No.)
13. ORGANIZATION Manufacturing Address: Show the complete address of the location where the product
was manufactured.

SUBMISSION INFORMATION
14. Customer Name/ Division: Show the corporate name and division or operations group. (Volvo purchasing
company, e.g. Volvo 3P, Volvo Powertrain, etc.)
15. Contact Name: Enter the name of your customer contact. (Volvo SQA and/or Volvo purchaser.)
16. Application: Enter the model year, vehicle name, or engine, transmission, etc.
17. Check the appropriate box to indicate Substances of Concern (Volvo black list STD 1009,1)/ISO
marking reporting.

REASON FOR SUBMISSION

18. Check the appropriate box. Add explanatory details in the "other" section.

REQUESTED SUBMISSION LEVEL

19. Identify the submission level requested by your customer. Check the submission items if a level 4 is
requested.
If not otherwise agreed Volvo request level 4. The minimum required mandatory documents are:
6. Process FMEA;
7. Control Plan;
9. Dimensional Results including Marked Drawing;
10. Material, Performance Test Results;
13. Appearance Approval Report (if applicable);
17. Records of Compliance with Volvo Specific Requirements (RTS). Mandatory for Volvo Powertrain.
18. Part Submission Warrant (PSW).
All other documents shall be submitted to Volvo upon request.
DECLARATION
20. Explanation/Comments: Provide any explanatory details on the submission results; additional information
may be attached as appropriate.
21. Enter the number or code that identifies the specific mold, cavity, and/or production process used to
manufacture the sample parts.
22. The responsible supplier official, after verifying that the results show conformance to all customer
requirements and that all required documentation is available shall approve the declaration and provide Title,
Phone Number, Email Address, and Fax Number.

FOR CUSTOMER USE ONLY

Leave blank
 APPEARANCE APPROVAL REPORT
PART DRAWING APPLICATION
NUMBER NUMBER (VEHICLES)

PART BUYER E/C LEVEL DATE

NAME CODE

ORGANIZATION MANUFACTURING SUPPLIER/VENDOR

NAME LOCATION CODE
OTHER
REASON FOR PART SUBMISSION WARRANT SPECIAL SAMPLE RE-SUBMISSION
SUBMISSION PRE TEXTURE FIRST PRODUCTION SHIPMENT ENGINEERING CHANGE

APPEARANCE EVALUATION

ORGANIZATION SOURCING AND TEXTURE INFORMATION AUTHORIZED CUSTOMER

PRE-TEXTURE REPRESENTATIVE
EVALUATION SIGNATURE AND DATE
CORRECT AND
PROCEED

CORRECT AND
RESUBMIT

APPROVED TO
ETCH/TOOL/EDM

COLOR EVALUATION
COLOR
METALLIC SHIPPING PART
TRISTIMULUS DATA HUE VALUE CHROMA GLOSS BRILLIANCE SUFFIX DISPOSITION
COLOR MASTER MASTER MATERIAL MATERIAL
SUFFIX DL* Da* Db* DE* CMC NUMBER DATE TYPE SOURCE RED YEL GRN BLU LIGHT DARK GRAY CLEAN HIGH LOW HIGH LOW

COMMENTS

PHONE DATE DATE

ORGANIZATION NO. AUTHORIZED CUSTOMER
SIGNATURE REPRESENTATIVE SIGNATURE

March CFG-1002
2006
 APPEARANCE APPROVAL REPORT
PART DRAWING APPLICATION
NUMBER 1 NUMBER 2 (VEHICLES) 3

PART BUYER E/C LEVEL DATE

NAME 4 CODE 5 6/7

ORGANIZATION MANUFACTURING SUPPLIER/VENDOR

NAME 8 LOCATION 9 CODE 10

OTHER
REASON FOR PART SUBMISSION WARRANT SPECIAL SAMPLE RE-SUBMISSION
SUBMISSION 11 PRE TEXTURE FIRST PRODUCTION SHIPMENT ENGINEERING CHANGE

APPEARANCE EVALUATION
12 AUTHORIZED CUSTOMER
ORGANIZATION SOURCING AND TEXTURE INFORMATION
PRE-TEXTURE 13 REPRESENTATIVE
EVALUATION SIGNATURE AND DATE
CORRECT AND
PROCEED

CORRECT AND
RESUBMIT

APPROVED TO
ETCH/TOOL/EDM

COLOR EVALUATION 21
22
14 15 16 17 18 19 20
COLOR
METALLIC SHIPPING PART
TRISTIMULUS DATA HUE VALUE CHROMA GLOSS BRILLIANCE SUFFIX DISPOSITION
COLOR MASTER MASTER MATERIAL MATERIAL
SUFFIX DL* Da* Db* DE* CMC NUMBER DATE TYPE SOURCE RED YEL GRN BLU LIGHT DARK GRAY CLEAN HIGH LOW HIGH LOW

COMMENTS
23

PHONE NO. DATE DATE

ORGANIZATION 24 AUTHORIZED CUSTOMER 25
SIGNATURE REPRESENTATIVE SIGNATURE

March CFG-1002
2006
Appendix B - Completion of the Appearance Approval
Report
1. Customer part number: Engineering released customer part number.
2. Drawing Number: Use the number of the drawing on which the part is shown if different from the
part number.
3. Application: Enter the model year(s) and vehicle or other program on which the part is used.
4. Part Name: Use the finished part name on the part drawing.
5. Buyer Code: Enter the code for specific buyer or part.
6./7. E/C Level & Date: Engineering change level and E/C date for this submission.
8. Organization Name: Organization responsible for submission (include supplier if available).
9. Manufacturing Location: Location where part was manufactured or assembled.
10. Supplier/Vendor Code: Customer-assigned code for organization location where the part was
manufactured or assembled.
11. Reason for submission: Check box(es) explaining the reason for this submission.
12. Organization Sourcing & Texture Information: List all first surface tools, graining source(s),
grain type(s), and grain and gloss masters used to check part.
13. Pre-Texture Evaluation: To be completed by authorized customer representative (not used by
GM).
14. Color Suffix: Use alphanumeric or numeric color identification
15. Tristimulus Data: List numerical (colorimeter) data of submission part as compared to the
customer-authorized master.
16. Master Number: Enter alphanumeric master identification (not used by Ford).
17. Master Date: Enter the date on which the master was approved.
18. Material Type: identify first surface finish and substrate (e.g;, paint/ABS).
19. Material Source: Identify first surface and substrate suppliers. Example: Redspot/Dow.
20. Color Evaluation, Hue, Value, Chroma, Gloss and Metallic Brilliance: Visual
assessment by customer
21. Color Shipping Suffix: Color part number suffix or color number.
22. Part Disposition: To be determined by customer (approved or rejected).
23. Comments: General comments by the organization or customer (optional).
24. Organization Signature, Phone No. & Date: Organization certification that the document
information is accurate and meets all requirements specified.
25. Authorized Customer Representative Signature & Date: Authorized Customer
Representative approval signature.

THE AREAS INSIDE THE BOLD LINES ARE FOR CUSTOMER USE ONLY.
Appendix C - Production Part Approval, Dimensional
Results
Production Part Approval
Dimensional Test Results

ORGANIZATION: PART NUMBER:

SUPPLIER/VENDOR CODE: PART NAME:
DESIGN RECORD CHANGE LEVEL:
INSPECTION FACILITY: ENGINEERING CHANGE DOCUMENTS:

SPECIFICATION / TEST QTY. ORGANIZATION MEASUREMENT NOT

ITEM DIMENSION / SPECIFICATION LIMITS DATE TESTED RESULTS (DATA) OK OK

Blanket statements of conformance are unacceptable for any test results.

March CFG-1003 SIGNATURE TITLE DATE
2006
Appendix D - Production Part Approval, Material Test
Results
Production Part Approval
Material Test Results

ORGANIZATION: PART NUMBER:

SUPPLIER/VENDOR CODE: PART NAME:
DESIGN RECORD CHANGE LEVEL:
MATERIAL SUPPLIER: ENGINEERING CHANGE DOCUMENTS:
*CUSTOMER SPECIFIED SUPPLIER/VENDOR CODE:
*If source approval is req'd, include the supplier (Source) & Customer assigned code NAME OF LABORATORY:

SPECIFICATION / TEST QTY. NOT

MATERIAL SPEC. NO. / REV / DATE LIMITS DATE TESTED SUPPLIER TEST RESULTS (DATA) OK OK

Blanket statements of conformance are unacceptable for any test results.

March CFG-1004 SIGNATURE TITLE DATE
2006
Appendix E - Production Part Approval, Performance Test
Results
Production Part Approval
Performance Test Results

ORGANIZATION: PART NUMBER:

SUPPLIER/VENDOR CODE: PART NAME:
DESIGN RECORD CHANGE LEVEL:
NAME OFLABORATORY: ENGINEERING CHANGE DOCUMENTS:
*CUSTOMER SPECIFIED SUPPLIER/VENDOR CODE:
*If source approval is req'd, include the supplier (Source) & Customer assigned code

SPECIFICATION / TEST QTY. SUPPLIER TEST RESULTS (DATA) / NOT

TEST SPECIFICATION / REV / DATE LIMITS DATE TESTED TEST CONDITIONS OK OK

Blanket statements of conformance are unacceptable for any test results.

March CFG-1005 SIGNATURE TITLE DATE
2006