Champion Aerospace
1230 Old Norris Road • Liberty, SC 29657 • Email: purchasing@champaero.com • Fax: 864-843-5470
Supplier Request for Deviation/Waiver
(Reference Procedure 13-4)

Note: All boxes in yellow are required to be filled in.

Date July 9, 2008
Champion Use Only
Control No.  
Item No.  
Waiver (authorization to ship nonconforming material)
Deviation (prior to manufacture) 
Supplier Name Contact Name
Supplier Code Part No. Quantity
Phone No. Fax PO Number
Description Drawing Revision
Drawing or Specification Requirement
Deviation/Nonconformance (waiver)
Reason for deviation/root cause of nonconformance (waiver)
Long term recommendation/corrective action (waiver)
Completed by
Corrective action effective date 
NOTE: Copy of approved requests must accompany shipment of parts. Approval to ship parts
prior to dispositon must be obtained in writing by the purchasing agent (include appproval letter
and waiver request with shipment).
Champion Aerospace Use Only
MRB Disposition: Approved Denied
Comments:
 
 
Product Engineering: Date:
Quality Assurance: Date:
Manufacturing Engineering:   Date:
Customer:   Date:
 
Distribution:Original — MRB; File Copy — Purchasing
FORM 113008 07/07