Terminal Crimp Process Verification Report

Report No.:

Project Name:

Manufacturer:

Project Type:

Preparing Location:

Requested By:

Request Date:

Prepared By:

Completion Date:

This verification report only shows that the design is centered and the manufacturing process is capable.

By signing below, supplier is certifying the following:

1) The information and data contained within this report is true and accurate.

2) A day-to-day process control plan is in place that assures parts are produced to a Cpk of 2 or better.

3) This verification report and the supplier's day-to-day process control plan will be included with the FPA      submittal to the using division.

Certified By:

Signature

Print Name

Date:

Authorized Supplier Representative

dd-mm-yy

Phone

Email