Part Submission Warrant  -  Supplier Compliance Certification
Supplier hereby certifies that it has received and reviewed TIs Specification 6458266, understands its requirements, and has completed the required PPAP elements. Supplier hereby represents and warrants that the information provided in this Certification is true and correct as of this date.    

NOTICE: The act of submitting this certificate shows Supplier's agreement to be bound by the information and this Certification.

*Supplier Part Number / Description  
*TI Part Number  
*TI Part Revision  
*Material Group  
*Safety and/or Government Regulations ("Yes" if so indicated by the design record, otherwise "No".)                                    
*Supplier Name  
Supplier Code
*Street Address  
*City  
*State/Province  
Postal Code
*Country  
Customer Name: Texas Instruments
Buyer
Buyer Code
Application ((If known, Ex. 20x20 QFP, 16 pin SOIC)
*Reason for Submission (Check one or more)
- Initial Submission  
- Change to Optional Construction or Material  
- Engineering Change(s)  
- Sub-Supplier or Material Source Change  
- Tooling: Transfer, Replacement, Refurbishment, or additional  
- Change in Part Processing  
- Correction Of Discrepancy  
- Parts Produced at Additional Location  
- Tooling inactive for more than 1 year  
- Other(Please specify)
*Requested Submission Level                                      
*Do Submission Results as defined in Appendix B of TI document 6458266 and all process parameters meet all drawing and specification requirements?  
If NO please explain:
Declaration: I affirm that the samples represented by this warrant are representative of our parts, which were made by a process that meets all Production Part Approval Process Manual 4th Edition Requirements. I also certify that documented evidence of such compliance is on file and available for review. I have noted any deviation from this declaration to the right: PSW Waiver Form
*Name  
*Title  
*Email    
*Phone