*Form no: SS01

Amendment No: 1
Amendment Date: 22/07/2013

Sample Development Request Form

Indenting Department MCOE Development Request No
Requested Date 13.02.2018 Required Date 19.02.2018
To Be Filled by Indenting Department
☐ Design change ☐ Process change ☐ New part development ☐ Cost saving ☒ Testing
Part Name Threshold sill
1.NAA280R1
2.NAA23221C1
Part no.
3.FBA280AW5
4.NAA5711AB1
Supplier part no (Ordering code) *
Program Testing purpose
Product Type Prima S Landing
Sample Qty 1 Nos
Recommended Source if any
Justification for Source
Please Specify if there is any need of specific Documents/ Validation Test Reports along with sample
Quality Inspection report

Requested by Approved by
Mathan kumar Mahesh Hegde

* Pls mention Supplier material code in case of OEM Supplier like Tyco, Omron etc
**Request to be accompanied with relevant Dwg, Data Sheets, Std if

To Be filled by Strategic Sourcing

DR received Date Proposed Date Actual Date
Project Leader Project Co Lead
Supplier Identified
Remarks
Approved by