SUPPLIER Deviation Report

☐ Concession (CON)
☐ Deviation Permit (DP)

To be completed by coordinator CON/DP № 2021/GVC

☐ full PIR 40A3/007
☐ reduced PIR (only step 5 and 6)
☐ no PIR

CON/DP/PIR Coordinator: Vendor Code or Plant Code / Dept: Related notification №’s.
Sandip Thakare 700000456      
Tel:
+91 8454940312 Vendor or Plant / Dept name: PTC Industries Ltd Reference №
Fax:      
      Contact name:Shubham Verma Date CON/DP issued:
E-mail: 23.02.2021
sandip.thakare@km.kongsber Tel: +91 9076600635
g.com Order №
Fax: KO0136298/ DT 06.03.2020
E-mail: shubham@ptcil.com
Part № RRM900000073 Vendor Part No. Serial / Batch No. Quantity
20BRV-1 01 No
Process № Description: Site specific reference:
      GVC 40A3      

Description of Non-conformity (Define) or requested deviation and proposal for repair/rework:

During dimensional inspection of First Article, we have observed deviation in dimensions for Balloon # 3,6, 29 & 33 of
the attached Drawing The other interrelated dimensions are acceptable as per the drawing.
Kindly provide us the acceptance of this concession as it is.
SUPPLIER Deviation Report

☐ Concession (CON)
☐ Deviation Permit (DP)

To be completed by coordinator CON/DP № 2021/GVC

☐ full PIR 40A3/007
☐ reduced PIR (only step 5 and 6)
☐ no PIR

CON/DP/PIR Coordinator: Vendor Code or Plant Code / Dept: Related notification №’s.
Sandip Thakare 700000456      
Tel:
+91 8454940312 Vendor or Plant / Dept name: PTC Industries Ltd Reference №
Fax:      
      Contact name:Shubham Verma Date CON/DP issued:
E-mail: 23.02.2021
sandip.thakare@km.kongsber Tel: +91 9076600635
g.com
Fax:
E-mail: shubham@ptcil.com

AREA/CELLS FOR DECISION

Accepted
Estimated cost of repair:
To be repaired by customer      

Back after repair:

To be returned to the supplier for repairs      
Expected delivery time:
Repaired by supplier prior to delivery      
New delivery time:
     
Rejected

Comment:

Date: Signature:
Design Non-Conformance Authority            
acceptance

Supplier is also requested to answer the Problem Improvement Request in order to describe the measures taken in order to
eliminate the cause for this non-conformity. The non-conformity will not be closed until both documents have been received.

If 48 hrs Containment Check Sheet has been issued this needs to be prioritized.
Latest date of reply for Concession report (CON):      

Latest date of reply for Problem Improvement Request (PIR):      

Date: Signature:
Supplier’s acceptance            

Applicability: Marine

Title:Concession_Form_Marine 
Author: Giso Heising

Document Owner: Andrew Wall

Version number:  1.0

Issue Date and Change History:

1.0 14/Nov/2014 Initial Issue in Global Supplier Portal for Marine Concession/Deviation Report
2.0 07/Mar/2016 Updates for Deviation Permit, PIR follow up and DCA signature
3.0 15/Feb/2018 Added new version control sheet
4.0 22/Oct/2018 Removal of RR References
5.0 24/Apr/2019 Add KM Logo and comment field for “acceptanced”