Supplier Concession Form

To be completed by coordinator Concession №

Full problem solving (e.g., 8D)

Reduced problem solving (root cause investigation and corrective actions)

Coordinator: Supplier code: Related notification №’s.

Tel: Supplier name:

Vendor NC Reference №

Fax: Contact name:

Date CON issued:

E-mail: Tel:

Fax: Order №

E-mail:

KM Part № Supplier Part No. Serial / Batch No. Quantity

Description: KM NC reference:

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

KONGSBERG PROPRIETARY. This document and its accompanying elements contain KONGSBERG information which is proprietary and confidential.
Any disclosure, copying, distribution or use is prohibited if not otherwise explicitly agreed with KONGSBERG in writing. Any authorized reproduction, in
whole or in part, must include this legend. ©2023 KONGSBERG - All rights reserved.

KM-FORM-0092 Supplier Concession Form / Rev. 1 / Page 1 of 4

PUBLIC
 Kongsberg Maritime

To be completed by coordinator Concession №

Full problem solving (e.g., 8D)

Reduced problem solving (root cause investigation and corrective actions)

Coordinator: Supplier code: Related notification №’s.

Tel: Supplier name:

Vendor NC Reference №

Fax: Contact name:

Date CON issued:

E-mail: Tel:

Fax: Order №

E-mail:

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:

KONGSBERG PROPRIETARY – see Statement of Proprietary Information

KM-FORM-0092 Supplier Concession Form / Rev. 1 / Page 2 of 4

PUBLIC
 Kongsberg Maritime

To be completed by coordinator Concession №

Full problem solving (e.g., 8D)

Reduced problem solving (root cause investigation and corrective actions)

Coordinator: Supplier code: Related notification №’s.

Tel: Supplier name:

Vendor NC Reference №

Fax: Contact name:

Date CON issued:

E-mail: Tel:

Fax: Order №

E-mail:

Design Non-Conformance Date: Signature:

Authority acceptance

Supplier is also requested to answer the 8D-Report 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.

Latest date of reply for Concession report (CON):

Latest date of reply for 8D-Report:

Date: Signature:
Supplier’s acceptance

KONGSBERG PROPRIETARY – see Statement of Proprietary Information

KM-FORM-0092 Supplier Concession Form / Rev. 1 / Page 3 of 4

PUBLIC
 Kongsberg Maritime

KONGSBERG PROPRIETARY – see Statement of Proprietary Information

KM-FORM-0092 Supplier Concession Form / Rev. 1 / Page 4 of 4

PUBLIC