Permanent Change Request Temporary Deviation Request

CR No: Duration / Qty Effected:

(Assigned By Cross)
Request Date:

SUPPLIER TO COMPLETE

SUPPLIER NAME AND ADDRESS (Complete) PART NAME / NUMBER / REVISION LEVEL PERSON SUBMITTING ON BEHALF OF SUPPLIER

Describe and compare below the changes requested to current product features/requirements:

CONDITION NECESSITATING REQUEST: (What caused the part / process to go out of spec?) Submit supporting data if applicable

CORRECTIVE / PREVENTATIVE ACTION: (What actions are taken to correct this in the future?) Submit supporting data if applicable

Note: All Changes Must Have Cross Approval Prior To Implementation. Estimated Timing Prior to Permanent Change Implementation is 6 to 12 Weeks After Approval. Note
Required Signatures Below Before Seller Can Proceed with Change.
DESCRIPTION / REASON OF CHANGE: DESIGN COMPOSITION WEIGHT PROCESSING
EFFECT OF CHANGE:
Product Improvement Yes No Drawing Update Yes No Material Change Yes No
Process Improvement Yes No Sub-Supplier Change Yes No Capacity Change Yes No
SUPPLIER TESTING/VALIDATION PLAN (Where Applicable):

COMMERCIAL IMPACT (COST) - If Applicable SUPPLIER FMEA/CONTROL PLAN AFFECTED

TOOLING AND/OR FACILITY CHANGES? YES NO YES NO
IF YES, PLEASE STATE COST (Include Currency)
PIECE PRICE AFFECTED? YES NO IF YES, BRIEFLY DESCRIBE CHANGES AND/OR ATTACHED UPDATED COPIES
IF YES, PLEASE STATE COST £

CROSS BUYER TO COMPLETE

WHERE USED - PART NUMBERS AFFECTED BY CHANGE: SITE AFFECTED CUSTOMERS AFFECTED

CROSS TECHNICAL ENGINEERING/PROGRAM MANAGEMENT TO COMPLETE

INTERCHANGEABILITY AFFECTED WILL INCORPORATION OF CHANGE AFFECT SHIPPING SCHEDULE?
ASSEMBLY YES NO YES NO

COMPONENTS YES NO
CONDITIONAL APPROVAL ACTIONS REQUIRED PRIOR TO APPROVAL REJECTED
YES NO REQUIRED YES NO REQUIRED
SUPPLIER TESTING/VALIDATION PLAN
CROSS TESTING/VALIDATION PLAN
Reason:
END CUSTOMER TESTING/VALIDATION REQUIRED
SUPPLIER PPAP SUBMISSION/APPROVAL SUPPLIER PPAP/FAIR SUBMISSION/APPROVAL

CROSS ACTIONS/PROCEDURES REQUIRED PRIOR TO IMPLEMENTATION (check all that apply)

PROCESS CHANGE PRODUCTION TRIAL RUN CUSTOMER NOTIFICATION REQUIRED SAMPLE OF CHANGED COMPONENT REQUIRED YES NO
DESIGN CHANGE TOOL ORDER/RELEASE CUSTOMER APPROVAL REQUIRED IF YES, STATE QUANTITY & TIMING
DVP&R NO CUSTOMER NOTIFICATION REQUIRED

PERMANENT CHANGE APPROVALS:

SDE/SQE: DATE BUYER: DATE

DATE PRODUCT MGR. DATE

TECHNICAL ENG.

PRODUCT DATE
QUALITY MGR.

MFG. MGR. DATE

Note: No Changes Can Be Made Until Signed Supplier CR is Received, PPAP / FAIR is Approved and Implementation Timing Is Agreed Upon

TEMPORARY DEVIATION APPROVALS:

PRODUCT DATE TECHNICAL ENG. DATE

QUALITY

SDE/SQE DATE DATE

MATERIAL CONTROL

* This approval is granted upon the understanding that it is advisory in nature and in no manner changes the Sellers original responsibility for insuring that all characteristics, designated in the applicable
engineering specifications and/or inherent in the samples as originally tested and approved, are maintained. Seller accepts full responsibility for the changes or types of changes listed above; and should
such changes result in less satisfactory performance than experienced with the originally approved item, Seller will fully reimburse the Buyer for all expenses incurred to correct the deficiency.

412504413.xls.xls Page 1 of 1 Rev Date: 27-MAY-08