ANPQP v 3.

1
ANPQP - PART SUBMISSION WARRANT (PSW)

R / N Project: Safety Nissan Impt A Impt B Impt C OBDDoc. Ref. No./Ver

Doc Rev. Date:
Regulation Renault 1 2
Doc. Origin Date
Supplier Name: Supplier Code: E-mail:
Supplier Plant: Author: Tel:
Part Name: Control Plan Reference / Version:
Part No. & Issue Level Control Plan Revision Date:
Design Note No. / DEVO Average Weight:
Drawing No: R / N Plant:
First Part Delivery Date:

Initial Submission Process Change Tooling Change Details / Other:

Reason for
Design Change Sub-Supplier Change Tooling Refurbishment/Replacement
submission
Material Change Location Change Re-submission

Items attached to this Submission Warrant:

Control Plan Engineering Drawings Part Number Details
Process Flow Chart Component Supply Chain Chart Logistics and Packaging Data Sheet
Gauge Specification / Approval Design / Process / Facility Change
Inspection Report (including IMDS ID) Request
Report Full Volume Confirmation Audit
Sub-components PSW or
Supplier Test Plan & Report equivalent Result
Process Capability Study Parts Capacity Submission Warrant
Result
Appearance Approval Report Design Note Other

For each supporting document, indicate the issue level and date on an attached list.

Submission Acceptability
Dimensional Requirements The results meet all drawing and specification requirements:
OK
Appearance Requirements OK
If NO, explanation required:
Material Requirements OK
Functional Requirements OK
Statistical Process Data OK
Component Marking OK
Full Volume Confirmation Audit Result
OK

Declaration
I confirm that the samples covered by this documentation are representative of production parts and have been manufactured to the
relevant drawings and specifications with no off-standard operations in the production process. Any deviations from this declaration
are as follows:

Name: Position:

Signature: Date:

RENAULT / NISSAN APPROVAL

Interim Approval
Approved Rejected
Approval

Name: Name:

Position: Position:

Signature: Signature:

Date: Date:

Note: Approval by Renault and / or Nissan shall not relieve the supplier in any way from its responsibilities

RENAULT / NISSAN COMMENT (mandatory in the case of Interim Approval or Rejection):

Copyright © Renault/NISSAN All Rights Reserved