GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

PT. Ratu Magenta

Complaint No. :

Address

CIF No.: 016/WEB/VIII/2026

Phone

PIC

Invoice No. :

PO

Quantity Order

Product : TINTA PROSES WEB UV

Quantity Complaint

Specification : INKW UV WEB MAGENTA CRM-X @5KG

Problem :

HASIL CETAK MENGALAMI BINTIK-BINTIK
	DO/26/VII/015056

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :

In Words

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

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 :

TUKAR GULING

Jakarta, 15 Agustus 2026

Prepared by,

Checked by,

Approved by,

15-08-2026

( Nurul )

20-08-2026

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )