Form-17 Rev.3.1
Vendor > JVC KENWOOD > Vendor (copy)
JVC KENWOOD Corporation
Procurement department manager No.
Special Usage Request Issued on: , 20
Vendor name:
Acknowledgment by JVC KENWOOD / Dept.:, 20 / Approval / Review / Issue
Parts number / Subject planning code / Delivery / Model no. / Samples
Yes/No
Parts name / Assembly planning code / Quantity / Model name / Document
Yes/No
Special usage detail
Compensation: Yes/No
Cause and countermeasures
Conclusion/Instructions / □ Accepted □ Rejected
Reason (conditions)
QA / Eng. / Proc.
Approval / Approval / Issue
Vendor > JVC KENWOOD > Vendor (copy)
JVC KENWOOD Corporation
Procurement department manager No. (1)
Special Usage Request Issued on: (2) , 20
Vendor name: (3)
Acknowledgment by JVC KENWOOD / (4) Dept.:(6) , 20 / Approval / Review / Issue
(7) / (7) / (5) / (5) / (5)
Model / Parts number / (8) / Subject planning code / (10) / Delivery / (12) / Model no. / (14) / Samples
Yes/No
Model / Parts name / (9) / Assembly planning code / (11) / Quantity / (13) / Model name / (15) / Document
Yes/No
Special usage detail / (16)
Compensation: Yes/No (17)
Cause and countermeasures / (18)
Conclusion/Instructions / □ Accepted □ Rejected (19)
Reason (conditions)
(20) / (21) / (21) / (21).
Approval / Approval / Issue
(22) / (22) / (22)
To complete a "Form-17: Special Usage Request":
Should you have any questions, please contact the Procurement Office of JVC KENWOOD.
No. / Subject / What to describe? / For JVC KENWOOD Use：Y1 / No. / A number assigned by a procurement department. / Y
2 / Issued on: / The date on which this Special Usage Request was issued.
3 / Vendor name / The name of the vendor that issued this Special Usage Request.
4 / Dept.: / The name of the vendor's department that issued this Special Usage Request.
5 / Issue, Review, Approval / The signatures of an issuer, reviewer, and approver of the vendor that issued this Special Usage Request.
6 / Date / The date on which this Special Usage Request was received.
7 / Acknowledgment by JVC KENWOOD / The signature of a person who received this Special Usage Request. / Y
8 / Parts number / The JVC KENWOOD parts number of the subject component.
9 / Parts name / The name of the subject component in JVC KENWOOD.
10 / Subject planning code / The planning code that appears on the corresponding delivery slip.
11 / Assembly planning code / The planning code of end-products for which the special usage components/products are to be used.
12 / Delivery / The scheduled delivery date of the special usage component/product.
13 / Quantity / The quantity of the special usage component/product to be used.
14 / Model no. / Describe the JVC KENWOOD model number (Yxx-xxxx-xx, Xxx-xxxx-xx) that will be manufactured under the planning code to which the special usage components (or product) are to be used. Indicate "Yes" or "No" depending on whether samples are available.
15 / Model name / Describe the model names for which the special usage components (or product) are to be used, and indicate "Yes" or "No" depending on whether samples are available.
16 / Special usage detail / Specifically describe the situation (failure) for which this special usage is needed.
17 / Compensation / Mark "Yes" or "No" depending on whether any compensation is required.
18 / Cause and countermeasures / Reason for the failure that has caused this special usage, countermeasures against the failure, and recurrence prevention measures.
19 / Conclusion/ instructions / Check "Accepted" or "Rejected" depending on whether this special usage should be accepted. / Y
20 / Reason / Reason of rejection or, when accepted, any conditions for accepting this special usage. / Y
21 / G, Div. / The procurement department that transfers the vendor the conclusion of this Special Usage Request. / Y
22 / Issue, Approval / The signatures of a person who replies to this Special Usage Request and one who approves the reply, and their dates. / Y
Effective Date / Rev.No. / Background at the time of establishment, commentary at the time of amendment, and particulars of amendment
2016-03-01 / Rev.(3.0) / Version unification
2017-02-06 / Rev.(3.1) / ·Change to the form " Accepted/Rejected" field