Certificate of Source Inspection Acceptance

CERTIFICATE OF SOURCE INSPECTION ACCEPTANCE /
G 028525
SECTION 1
SUPPLIER NAME /

SUPPLIER NUMBER

PART NUMBER

PURCHASE ORDER NUMBER

PURCHASE ORDER LINE ITEM

PART REVISION LEVEL
LOT/JOB CONTROL NUMBER / SERIALNUMBERRANGE (AS APPLICABLE) / QUANTITY ACCEPTED

NORTHROP GRUMMAN SUPPLIER SQ

NGSQ STAMP

DATE ACCEPTED

SIGNATURE AND STAMP IMPRESSION INDICATE NORTHROP GRUMMAN SOURCE ACCEPTANCE OF SUPPLIER’S LOTAS DESCRIBED IN THE SECTION ABOVE. THIS FORM SHALL BE USED AS A RECORD OF SOURCE ACCEPTANCE WITH THE ORIGINAL COPY RETAINED AT THE SUPPLIER. PHOTOCOPIES OF THIS FORM SHALL ACCOMPANY EACH PARTIAL SHIPMENT OF THE LOT.
SECTION 2
PURCHASE ORDER LINE ITEM / SHIPPING DOCUMENT NO. / SHIPPING DATE / PARTIAL SHIPMENT QTY / REMAINING QUANTITY / SUPPLIER QA STAMP
SUPPLIER QA STAMP IMPRESSION SIGNIFIES THAT ALL INFORMATION ENTERED IN THIS SECTION IS CORRECT. PARTIAL SHIPMENT AND REMAINING QUANTITIES SHALL PROVIDE PART ACCOUNTABILITY TO THE ORIGINAL LOT QUANTITY ACCEPTED BY NORTHROP GRUMMAN SUPPLIER QUALITY.

CONTINUATION SHEET. ENTER SERIAL NUMBER FROM PAGE 1.

G028525

SUPPLIER NAME

PART NUMBER

LOT/JOB CONTROL NUMBER

PURCHASE ORDER
LINE ITEM / SHIPPING DOCUMENT NO. / SHIPPING DATE / PARTIAL SHIPMENT QTY / REMAINING QUANTITY / SUPPLIER QA STAMP
SUPPLIER QA STAMP IMPRESSION SIGNIFIES THAT ALL INFORMATION ENTERED IN THIS SECTION IS CORRECT. PARTIAL SHIPMENT AND REMAINING QUANTITIES SHALL PROVIDE PART ACCOUNTABILITY TO THE ORIGINAL LOT QUANTITY ACCEPTED BY NORTHROP GRUMMAN SUPPLIER QUALITY.

FORM INSTRUCTIONS

THE FIRST SECTION OF THE FORM SHALL BE COMPLETED BY ENTERING THE SUPPLIER NAME, SUPPLIER NUMBER, PART NUMBER, INITIAL NGAS PURCHASE ORDER NUMBER AND LINE ITEM, THE PART REVISION LEVEL (PER NGAS PO), THE SUPPLIER LOT/JOB CONTROL NUMBER (TRACEABLE CONTROL NUMBER UNIQUE TO THE MANUFACTURED LOT), THE SERIAL NUMBER RANGES (IF APPLICABLE), THE QUANTITY ACCEPTED, THE NG SQ REPRESENTATIVE NAME, THE DATE OF SOURCE INSPECTION ACCEPTANCE, AND THE NGQAACCEPTANCE STAMP IMPRESSION.

THE SECOND SECTION AND THE CONTINUATION SHEET SHALL BE COMPLETD FOR EACH PARTIAL SHIPMENT BY ENTERING ANY ADDITIONAL PURCHASE ORDER, LINE ITEM, THE SHIPPER NUMBER, DATE SHIPPED, THE QUANTITY SHIPPED, THE REMAINING LOT QUANTITY, AND THE SUPPLIER QA STAMP IMPRESSION. USE THE CONTINUATION SHEET ONLY WHEN NECESSARY TO DOCUMENT COMPLETE SHIPMENT OF THE LOT. RECORD THE FORM SERAIL NUMBER ON THE SUPPLIER PACKING SHEET/SHIPPER FOR CROSS-REFERENCE PURPOSES. EXAMPLE: “SOURCE INSPECTED ITEM, REFERENCE CSIA # CXXXXXX, COPY ATTACHED”

ANY CHANGES TO THE INFORMATION, LESS ADDITIONAL PO’S CONTAINED IN THE FIRST SECTION DURING THE COURSE OF SHIPPING PARTIAL QUANTITIES, SHALL REQUIREONSITE VERIFICATION BY NORTHROP GRUMMAN AND COMPLETION OF A NEW CERTIFICATE OF SOURCE INSPECTION ACCEPTANCE FORM.LOT QUANTITY SUBMITTED FOR SOURCE INSPECTION SHALL NOT EXCEED QUANTITY ON NG PURCHASE ORDER.

Q0-F045 (11-14)