SUPPLIER REQUEST FOR DEVIATION OR WAIVER

1.  TO:          __________________________________________________________

        PURCHASING:  _______________________________________________

2.  PURCHASE ORDER OR SUBCONTRACT NO.

3.  SUPPLIER NAME AND ADDRESS

________________________________________________________________________________________

________________________________________________________________________________________

4. DATE 

5. LOT NO. OR
PART S/N

6. 

CHARACTERISTICS THAT ARE AN ISSUE

7. DRAWING / SPECIFICATION REQUIREMENTS

8.     ACTUAL MEASUREMENT

9.     DISPOSITION*
(TO BE ASSIGNED BY TEM)

10.  CAUSE OF THE ISSUE(S)  (FURNISH SEPARATE STATEMENT FOR EACH TYPE OF DEFECT LISTED ABOVE)

11. ACTION TAKEN TO RESOLVE ISSUES

12. WHEN WILL ABOVE ACTION BECOME EFFECTIVE?:       

13.  THE SUPPLIER HEREBY CERTIFIES THAT THE ABOVE DESCRIBED MATERIAL DEVIATES FROM THE CONTRACTUAL REQUIREMENTS IN THE QUANTITIES AND CONDITIONS STATED AND THAT THE STATED ACTION HAS BEEN OR WILL BE TAKEN.

SUPPLIERS’S AUTHORIZED AGENT

TITLE

14. DRS TEM’s ACTION:       

15. ENGINEERING

DATE

QUALITY

DATE

PROGRAM MGT.

DATE

PURCHASING

DATE

*FINAL DISPOSITION IS DEPENDENT UPON RESULTS OF INSPECTION AT DRS TEST & ENERGY Management, LLC. (TEM)

Supplier is to fill in boxes 1 thru 13, except 9 and transmit to DRS Purchasing Representative.  DRS is to fill in boxes 9, 14 and 15 and transmit back to Supplier.  Supplier is to send a copy of the completed form with each shipment.