Contents	Page

1.	Scope of Application	2

1.1	Component identification	2

2.	Questions to component supplier	3

2.1	Which position do you assume within the supply chain of the component?	3

2.2	Describe your source of supply / supply chain (traceability)	4

2.3	What is your experience with the chosen source of supply?	5

2.4	How do you rate the components from a production perspective?	6

2.5	How do you rate the condition of the goods?	6

2.6	Is additional quality assurance testing required?	7

This Questionnaire must be attached to the respective application for deviation permit.

Scope of Application

This compilation of questions for the preparation of a deviation permit (DP) is to aid the supplier in listing and providing all component procurement data that are of relevance to Rolls-Royce Solutions for the DP to be prepared. The data provided by the supplier are binding and are used as a basis for the decision on further use of the components in volume production in mtu products.

This questionnaire applies to the procurement of active (e.g. memory, controllers, etc.), passive (capacitors, coils, etc.) and electromechanical (e.g. connectors, sockets, etc.) components for use in the print assembly of SMD, THT and press-fit technology.

Component identification

Please enter the data for component identification by the DP author.

mtu material number:
Manufacturer's component designation:
Component manufacturer:
Quantity / Amount offered:
Offer number
DP prepared by (company name):
DP prepared by (name, first name):
Date of DP preparation:

Questions to component supplier

Which position do you (as the contractual partner of Rolls-Royce Solutions)	assume within the supply chain of the component?

a. The component manufacturer has authorized us as suppliers for this component.

b. We are a distributor that has been released by Rolls-Royce Solutions, and we comply with MTQ5012.

c. We are a distributor that has been released by Rolls-Royce Solutions, but we do not comply with MTQ5012.

d. We are no distributor that has been released by Rolls-Royce Solutions. However, we do comply with MTQ5012.

e. We are no distributor that has been released by Rolls-Royce Solutions, and we do not comply with MTQ5012.

In addition: what experience do you have with the offered product group (e.g. active/passive components, controllers, ...)?

Describe your source of supply / supply chain (traceability)

Procurement channel

a. We verifiably source the component directly from the original manufacturer.
Please attach evidence.

b. We purchase the goods from a distributor authorized by the manufacturer.
Please provide evidence as far as possible.

c. We purchase the goods from a business partner who purchases his goods exclusively from the original manufacturer or from authorized distributors.
Please provide evidence as far as possible.

d. We purchase the goods from a distributor not authorized by the manufacturer.
Please provide evidence as far as possible.

e. We obtain the goods from an unknown source of supply.

Traceability

a. Tracing back to the manufacturer is available and can be disclosed if required.

b. Tracing to the manufacturer is available, but not disclosed.

c. Tracing to the manufacturer is not available.

What is your experience with the chosen source of supply?

(Is to be answerd only if the checkbox (c / d or e) and 2.2.2 (c) has been ticked at point 2.2.1)

a. Describe the source of supply. If possible, state the name of the source of supply.
b. Describe the trustworthiness of the source of supply and justify your assessment.
c. Describe your experience with this source of supply. How long has your supply source been trading with the offered product group (active/passive components, controllers, ...)?
d. Do you have negative experience with this source of supply? If yes, which ones?
e1. Can counterfeit (fraudulent) goods be excluded?
yes / no
e2. If e1 yes, what criteria lead to the assessment that counterfeit can be excluded?
f. Any further details on the component you want to share with Rolls-Royce Solutions?

How do you rate the components from a production perspective?

a. Assessment regarding processability (e.g. solderability of the component)
b. Information on date code
c. Information on country of manufacture
d. Information on component storage to date and on environmental influence on component (temperature, humidity, shock, etc.)
e. Other characteristics that deviate from new goods.

How do you rate the condition of the goods?

(multiple answers possible)

a. Goods are in original packaging

b. Goods are unused and new

c. Packaging type of goods deviates from that required by Rolls-Royce Solutions.

d. Condition of goods is unknown

Is additional quality assurance testing required?

Do you recommend that the goods be tested by an independent test service
(yes / no)?

Reason for evaluation:

i. No Why is the consultation of a testing body not required?
ii. Yes: 1. Which test service could you recommend based on your experience?
ii. Yes: 2. Which test steps must be performed to ensure component quality?

Do you already have a test document of a visual or functional test for the components?
(yes / no)?

If “yes”, please provide document.