“Form no: sot
‘Amondment No: 1
ologies Company ‘Amondment Date: 2210772013
Sample Development Request Form
Indenting Department | MCoE Development Request No
Requested Date | 13.11.2019, Required Date | 18.11.2019
“To Be Filled by indenting Department
Design change Process change [New part development | Bl Cost saving [1 Testing
Part Name
TNAASBGAOX2_SNNTERFACE BRACKET
Parte. DIN444A M6XQ5_4_6Z~M6 EYE BOLT
‘Supplier part no (Ordering code) *
Program
Product Type
Sample Qty 10 No's
Recommended Source if any
Justification for Source
Please Specify if th
‘any need of specific Documents/ Validation Test Reports along with sample
Quality Inspection report
Requested by ‘Approved by
Mathan Kumar KA.) Nobo kA — Mahesh Hegde Yoh
7 Fis mention Supper material coda in cave of OEM Supplier he Tyco, Omron ete
**equest to be accompanied with elevant Ow ate Sheets Stat
To Be filled by Strategic Sourcing
DR received Date Proposed Date ‘Actual Date
Project Leader Project Co Lead
Supplier Identified
Remarks
“Approved by