DEFAULT

29-October-2015
Document Detail
1

Type: DIV - FORMS

Document No.: QA0251[003]
Title: Supplier Notice of Change Agreement
Owner: WHITEFIELDP POR-08010633 Paul Whitefield
Status: CURRENT
Effective Date: 29-Oct-2015 Expiration Date:

Reference
Document No. Content Type Relation Fixed Rev Status
CQM0014-03 [001] DOCUMENT Related No CURRENT
Title:Supplier Selection and Approval Procedure
RPS100009 [002] DOCUMENT Related No CURRENT
Title:ACETONE
VA 5-4-002 [004] DOCUMENT Related No CURRENT
Title:Lieferanten auswählen u bewerten
PALL INT QProc 034 [07] DOCUMENT Related No EXPIRED
Title:Supplier Selection and Approval Procedure
FSBK_Pro_014 [001] DOCUMENT Related No CURRENT
Title:Beschaffung
DRE-PROC-04-04-023 [001] DOCUMENT Related No CURRENT
Title:Supplier Approval Procedure
EUPASS EU QP006 [002] DOCUMENT Master Document No CURRENT
Title:Supplier Approval Procedure
Q-P02-0005 [007] DOCUMENT Related No CURRENT
Title:Acceptance and evaluation of suppliers
PALL INT QProc 008 [016] DOCUMENT Related No CURRENT
Title:Supplier Management

Activities
Document Build No. Access Activity Accessed By Accessed Date
1 Check In SMARTADMIN 21-Sep-2015
Note:
 29-October-2015
Document Detail
2

Review

Build No.: 1 Closed Date: 29-Sep-2015

Review: Triennial Review
Review Purpose: Review of Documents every three years
Review Note: SYSTEM AUTO CLOSE REVIEW
Level Owner Role Actor Sign-off Date Sign-off By
10 DIV DOC CHANGE APPROVER BILICHM HAU-11592 Moira 29-Sep-2015 3:41 pm BILICHM HAU-11592
Corporate Document Change Bilich
Approver
Note To Approver:
Note From Approver:approved
10 DIV DOC CHANGE APPROVER HEIKE IDINK Heike Idink 25-Sep-2015 7:09 am HEIKE IDINK
Corporate Document Change
Approver
Note To Approver:
Note From Approver:approved
10 DIV DOC CHANGE APPROVER ORRM Matthew Orr 23-Sep-2015 5:25 pm ORRM
Corporate Document Change
Approver
Note To Approver:
Note From Approver:Approved.
10 DIV DOC CHANGE APPROVER WHITEFIELDP POR-08010633 22-Sep-2015 11:01 am WHITEFIELDP
Corporate Document Change Paul Whitefield POR-08010633
Approver
Note To Approver:
Note From Approver:Reviewed and approved
10 DIV DOC CHANGE APPROVER BAREEM Mark Baree 22-Sep-2015 11:14 am BAREEM
Corporate Document Change
Approver
Note To Approver:
Note From Approver:reviewed and approved
10 DIV DOC CHANGE APPROVER BERGERONS PNY-41634 Steve 25-Sep-2015 11:43 am BERGERONS PNY-41634
Corporate Document Change Bergeron
Approver
Note To Approver:
Note From Approver:Approved
10 DIV DOC CHANGE APPROVER COPPR SINGCO-08002273 28-Sep-2015 8:40 am COPPR SINGCO-08002273
Corporate Document Change Richard Copp
Approver
Note To Approver:
Note From Approver:approved
10 DIV DOC CHANGE APPROVER CUSICKT PNY-18726 Terry 21-Sep-2015 5:54 pm CUSICKT PNY-18726
Corporate Document Change Cusick
Approver
Note To Approver:
Note From Approver:Approved
10 DIV DOC CHANGE APPROVER DAVILAJO-PPR-30144 JOSE 28-Sep-2015 12:45 pm DAVILAJO-PPR-30144
Corporate Document Change DAVILA
Approver
Note To Approver:
Note From Approver:Approved
 29-October-2015
Document Detail
3
10 DIV DOC CHANGE APPROVER GRUMSKIR Robert Grumski 21-Sep-2015 8:39 pm GRUMSKIR
Corporate Document Change
Approver
Note To Approver:
Note From Approver:reviewed and approved
10 DIV DOC CHANGE APPROVER HAINESP Peter Haines 29-Sep-2015 10:53 am HAINESP
Corporate Document Change
Approver
Note To Approver:
Note From Approver:Approved
10 DIV DOC CHANGE APPROVER JONESP Paul Jones 21-Sep-2015 5:25 pm JONESP
Corporate Document Change
Approver
Note To Approver:
Note From Approver:Reviewed and approved
10 DIV DOC CHANGE APPROVER JULIE TUTTON Julie Tutton 28-Sep-2015 10:18 am JULIE TUTTON
Corporate Document Change
Approver
Note To Approver:
Note From Approver:.
10 DIV DOC CHANGE APPROVER PIETRIE-PPR-10006937 Emil Pietri 21-Sep-2015 5:46 pm PIETRIE-PPR-10006937
Corporate Document Change Porazza
Approver
Note To Approver:
Note From Approver:approved
10 DIV DOC CHANGE APPROVER ANDREW LAM - CY588546 22-Sep-2015 5:33 pm ANDREW LAM -
Corporate Document Change Andrew Lam CY588546
Approver
Note To Approver:
Note From Approver:I approve the agreement with the supplier for 3 years notification on discontinuity of any materials.

Note To Approver:
Note From Approver:
 DOC TYPE DOC NUMBER EFFECTIVE DATE REVISION
DIV - FORMS QA0251 10/29/2015 003
DEPARTMENT TITLE PAGE
Corporate QARA Supplier Notice of Change Agreement 1 of 2

Revision History
Revision Requested Revised By Description of Change Effective Change
No. By Date Order
Number
001 RB LL Introduction of form 06/22/2009 DIV CO-14
002 LH RB Introduction of new LS/PI 8th Oct 2012 DIV CO-8821
harmonized policies and
methods
003 Rob Grumski Rob Grumski Changes include, three-year See Header DIV CO
notice, addition of the Material 23387
Change email address, the 9
points to be communicated to
Pall and acknowledged and
agreed by Pall.

>>>>THIS DOCUMENT IS VALID ONLY FOR THE DATE PRINTED UNLESS STAMPED CONTROLLED AND SIGNED & DATED BY
THE QUALITY UNIT.<<<<
 DOC TYPE DOC NUMBER EFFECTIVE DATE REVISION
DIV - FORMS QA0251 10/29/2015 003
DEPARTMENT TITLE PAGE
Corporate QARA Supplier Notice of Change Agreement 2 of 2

______________________________________ [Please insert legal name] (“Supplier”) understands that products,

(“Products”), irrespective of when delivered, supplied to Pall Corporation (“Pall”), pursuant to our specifications and
purchase orders, will be used in certain critical filtration products. In order to enable Pall to determine if any proposed
change in Product(s) will have any effect on the safety and/or performance of Product(s), or Pall’s commitments to
regulatory agencies, commencing on the date hereof, Supplier agrees to notify Pall in writing at least three years prior to
making any change of the following aspects of the Product(s):

1. Composition of any raw material;

2. Source of any raw material;
3. Method of producing, processing or testing;
4. Change in subcontractors for producing, processing or testing;
5. Site of manufacture;
6. Any other material aspect of the Product.

Supplier notification to be emailed to materialchange@pall.com and include the following:

1. Detailed description of what is changing including composition, process, equipment or manufacturing location.
2. Part number affected including the Pall facilities that purchase the part number that is changing.
3. Date to make last purchase of the affected part number.
4. Any restrictions related to the old part number.
5. Date for the change to occur.
6. Date new material will be available for sampling and lead time.
7. Date new material will be available for Pall production requirements and lead time.
8. Documentation of the qualification process for the new material and the process to manufacture.
9. Supplier contact for all matters related to the material change.

Supplier’s delivery of product that fails to comply with any provisions of this Agreement will constitute nonconforming
goods and Pall may elect to, in addition to all remedies available by law and equity, have the nonconforming Goods
replaced, or corrected at Supplier’s expense.
_________________________________________[Please insert legal name] has agreed to conform to this
requirement, this day of ___________(month) _______(day) , 201_____.
Signature: ____________________________________________________
Name (printed): _______________________________________________
Title: ________________________________________________________
ACKNOWLEDGED AND AGREED:
PALL CORPORATION
By: _________________________________________________________
Name (printed): _______________________________________________
Title: ________________________________________________________

>>>>THIS DOCUMENT IS VALID ONLY FOR THE DATE PRINTED UNLESS STAMPED CONTROLLED AND SIGNED & DATED BY
THE QUALITY UNIT.<<<<