GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 007/WEB/II/2026

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 58 86 AQNA

Problem :

-FLUI

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 9.305.800.-

In Words

( Sembilan juta tiga ratus lima ribu delapan ratus rupiah )

Ect ..................................................................................................................................

Data :

Original sample / before process	Copy of DN
Sample after process	Photo
Comparison sample	Packaging
Inspection Card	Pull Tape ( for Picking / Dusting problem )
Ream Label
Ect

Notes :

NOMOR ID ROLL	QTY	KET' RUSAK
300899601	207	FLUI
NO.DO	5782314415 ( PRN/25/4765 )

300898905	575	FLUI

Jakarta, 25 Februari 2026

Prepared by,

Checked by,

Approved by,

25-02-2026

( Gita Siti )

25-02-2026

( Maurina Gurning )

( ........................ )

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )

PT Gelora Aksara Pratama