SMA Magnetics Sp. z o. o.	revision: 01.08.2025
Initial sample report
Supplier	Submission reason
New part
Re-sampling
Product Change (specification change)
Transfer of Production
Production Process Change
Production plant (if different than Supplier)	Production suspended longer than 12 months
Tool Change/ Correction
Change of Purchased Part
Change of Supplier
Others
Customer address
SMA Magnetics Sp. z o. o. ul. Komandosów 3/1 32-085 Modlniczka
Remarks
Enclosed
01 Dimensional test	09 Certificate of the coating	17 Confirmation of normative requirements (UL,IPC,ect)
02 Samples	10 Results of the pull force test	18 Product specification
03 Risk analysis - confirmation	11 Polished micrograph section analysis	19 Part history
04 Process flowchart	12 Optical 3D measurement	20 REACH declaration
05 Control Plan	13 Bill of materials	21 RoHS declaration
06 Process Capability Report	14 Sub-parts specification	22 Packaging instruction
07 Measurement Equipment Capability	15 Confirmation of conformance	23 Others
08 Material inspection certificate EN 10204 3.1	16 Material Safety Data Sheet - MSDS
Part Number (ERP)	Quantity of samples
Part Name	Netto part(s) weight
Drawing Number	Tool/cavity

Name, Surname	By signing this document supplier declares that the report was prepared according to SMA Magnetics Supplier Quality Manual.
Department
Telephone no
E-Mail	Signature
Date
List of provided documents
Document	Document date	Document name / page (if applicable)
01 Dimensional test
02 Samples
03 Risk analysis - confirmation
04 Process flowchart
05 Control Plan
06 Process Capability Report
07 Measurement Equipment Capability
08 Material inspection certificate EN 10204 3.1
09 Certificate of the coating
10 Results of the pull force test
11 Polished micrograph section analysis
12 Optical 3D measurement
13 Bill of materials
14 Sub-parts specification
15 Confirmation of conformance
16 Material Safety Data Sheet - MSDS
17 Confirmation of normative requirements (UL,IPC,ect)
18 Product specification
19 Part history
20 REACH declaration
21 RoHS declaration
22 Packaging instruction
23 Others

SMA Magnetics Sp. z o. o.
Part Number (ERP)	Quantity of samples
Part Name	Netto part(s) weight
Drawing Number	Tool/cavity

Name, Surname	By signing this document supplier declares that the report was prepared according to SMA Magnetics Supplier Quality Manual.
Department
Telephone no
E-Mail	Signature
Date