“Form no: sot ‘Amondment No: 1 ologies Company ‘Amondment Date: 2210772013 Sample Development Request Form Indenting Department | MCoE Development Request No Requested Date | 13.11.2019, Required Date | 18.11.2019 “To Be Filled by indenting Department Design change Process change [New part development | Bl Cost saving [1 Testing Part Name TNAASBGAOX2_SNNTERFACE BRACKET Parte. DIN444A M6XQ5_4_6Z~M6 EYE BOLT ‘Supplier part no (Ordering code) * Program Product Type Sample Qty 10 No's Recommended Source if any Justification for Source Please Specify if th ‘any need of specific Documents/ Validation Test Reports along with sample Quality Inspection report Requested by ‘Approved by Mathan Kumar KA.) Nobo kA — Mahesh Hegde Yoh 7 Fis mention Supper material coda in cave of OEM Supplier he Tyco, Omron ete **equest to be accompanied with elevant Ow ate Sheets Stat To Be filled by Strategic Sourcing DR received Date Proposed Date ‘Actual Date Project Leader Project Co Lead Supplier Identified Remarks “Approved by