GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 001/WEB/I/2024

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 70 82 RAP PREMIUM

Problem :

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 14.151.200.-

In Words

( Empat belas juta seratus lima puluh satu ribu dua 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 :

NO.DO	SJ23036/18911
NOMOR ID ROLL	QTY	  KET' RUSAK
1131363832	       500	 2500 EXP
1131363556	       564	 ROL BARU UTUH

Jakarta, 19 Januari 2024

Prepared by,

Checked by,

Approved by,

19-01-2024

( Gita Siti )

19-01-2024

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )