等级5──在供方处──保证书、零件、图纸、检查结果、试验室和功能结果、外观件批准报告、过程能力
结果、能力研究、过程控制计划、量具研究、潜在失效模式及后果分析（FMEA）。
Level 5-At Supplier Location-Warrant, Parts, Drawings, Inspection Results, Laboratory and Functional Result, Appearance
工程图纸更改水平Engineering Drawing Change level日期Date
附加工程更改Additional Engineering Changes__________________日期Date_____________________
图纸号码Shownon Drawing_________采购订单号码Purchase order No._____________重量Weight______kg
Approval Report, Process Capability Results, Capability Study , Process control Plan, Gauge Study, FMEA.
等级4──同前面等级3内容，但不包括零件。Level 4-Per level 3,but without parts.
Approval Report, Process Capability Results, Capability Study, Process Control Plan, Gauge Study, FMEA.。
提交结果SUBMISSION RESULTS
结果：The Results For尺寸测量Dimensional Measurement材料和性能试验Material and Functional Tests
零件加工过程更改Change in Part Process偏差校正Correction of Discrepancy
在其它地方生产零件Parts Produced at Additional Location其它---请说明Other—Please Specify
要求提交的等级（选择一项）REQUESTED SUBMISSION LEVEL(CHOOSE ONE)
等级3──在顾客处──保证书、零件、图纸、检查结果、试验室和性能试验结果、外观件批准报告、过程
能力结果、能力研究、过程控制计划、量具研究、FMEA。
Level 3-At Customer Location -Warrant, Parts, Drawing, Inspection Results, Laboratory & Functional Results, Appearance
批准Approval拒收Rejected其它Other________________
零件交接情况Part disposition
顾客姓名Customer Name______________顾客签字Customer Signature_____________日期Date____________
买方姓名/买方代码Buyer/Buyer Code_______________适用范围Application____________________
提交资料SUBMISSION INFORMATION:尺寸Dimensional材料/功能Functional外观Appearance
提交原因REASON FOR SUBMISSION：
地址Address____________________________________________________邮编Postal Code__________________
用户名称/部门Customer Name/Div._____________________________________________________________
检查用辅助工具号Checking Aid No._____工程更改水平Engineering Change Level______日期Date ________
供方制造厂资料SUPPLIER MANUFACTURING INFORMATION：
供方名称Supplier Name_____________________________________________供方代码Supplier Code__________
解释/说明EXPLANATION/COMMENTS：
打印体姓名Print Name职务Title电话号码Phone No.
授权的供方代表签字Supplier Authorized Signature日期Date
─────────────仅供顾客使用FOR CUSห้องสมุดไป่ตู้OMERUSE ONLY───────────────
声明DECLARATION
声明，本保证书使用的样品是我们的代表性零件；已符合顾客图纸和规范的要求；是在正常生产工装上使
用规定的材料制造而成，没有不同于正常加工过程的其它操作。与本声明有差异的地方已在下面作了说明。
I affirm that the samples represented by this warrant are representative of our parts and have been made to the applicable
等级1──保证书、外观件批准报告（只适用于指定外观项目的零件）
Level 1-Warrant,Appearance Approval Report(for designated appearance items only)
等级2──保证书、零件、图纸、检查结果、试验室和性能试验结果、外观件批准报告
Level 2-Warrant ,parts, Drawings, Inspection Results, Laboratory and Functional Results, Appearance Approval Report
首次提交Initial Submission更改可选用的结构或材料Change to Optional Construction or Material
工程更改设计Engineering Change分供方或材料来源更改Sub-Supplier or Material Source Change
工装：转换、代替、整修或附加Tooling: Transfer, Replacement, Refurbishment, or Additional
customer drawings and specifications and are made from specified materials on regular production tooling with no
operation other than the regular production process. I have noted any deviations from this declaration below:
零件提交保证书Part Submission Warrant编号No.
零件名称Part Name______________________________零件号和级别Part No. &Rev._______________________
安全/政府法规Safety /Government是Yes否No
外观标准Appearance Criteria统计过程数据Statistical Process Package
这些结果满足所有图纸和规范要求These results meet all drawing and specification requirements:是Yes否No
（如果选择‘否’应解释）(If ‘’No”- Explanation Required)