ASD-CERT	ACP008 - FORM01 – Part 1
Please complete this form and send to :	ASD-CERT   -   Secretray General   	

MANUFACTURING CHANGE REQUEST	Manufacturer's reference:

Manufacturer:	
Address:	

Products subject to certification:	
Product identification
(acc. to marking requirements in appl. std.):	Product qualification certificate number:	Issue date of the
PQ certificate	

	

	

	
Proposed changes:

Reasons for changes:

Effective date of change:	
For Manufacturer
Name		:

Signature:	Date: 	
Recommendation of Mandated Body:
Changed manufacturing route is sealed; doc. ref:	_________________________
A. m. changes to be certificated:	 yes	 no
Name:

Signature:	Date: 	
Decision of AECMA-CERT Executive Board member:
A.m. products of Manufacturer certificated: 	 yes	 no
	 yes on condition (see separate page)
Name:

Signature:	Date:	
Issue 006

ASD-CERT	ACP008 - FORM01 - Part 2
Change number :		
Date :	Page 1 of 1	

Check applicable column with respect to this change	Yes	No	
1.	Is there a change in material?			
2.	Is there a change in processing?			
3.	Is the source substantiation list affected			
4.	Is Reliability adversely affected?			
5.	Is Safety adversely affected?			
6.	Is Durability aversely affected?			
7.	Is there a change in component performance?			
8.	Is the intent of this change to fix a field problem?			
9.	Is the intent of this change to fix a problem on parts in process or parts to be delivered?			
10.	Does this change correct a non-conformance, which was previously accepted by ASD-CERT?			
11.	Does this change propose a part number or quantity change to purchased item part lists?			
12.	Does this change alter the appearance of a part?			
13.	Is physical or functional part interchangeability affected?			
14.	Is specification performance affected?			
15.	Is the weight of the part affected?			
16.	Any change of company name?			
17.	Any change of place of manufacture?			
18.	 Any change of sub-contractor?			
19.	Any change of Value Added Distributor?			
Explain each "Yes" answer in detail on an attached sheet and state why this change should not be a major change or join the qualification matrix proposed applicable test sequence	

Classification of reason for change (check applicable reason)	
A.	Product improvement		G.	Administrative error		
B.	Manufacturing base		H.	Cost reduction		
C.	Design error		I.	Customer request		
D.	Drawing error		J.	Supplier (internal or external) error		
E.	Obsolescence		K.	Impact due to REACH / RoHS		
F.	New regulation		L.	Out sourcing / Value Added Distributor