GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 001/WEB/I/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 70 73 RAP PREMIUM

Problem :

KERTAS YELLOWISH (BEDA SHADE WARNA)

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 62.245.500.-

In Words

( Enam puluh dua juta dua ratus empat puluh lima ribu lima 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 SJ24036/18219

Jakarta, 15 Januari 2025

Prepared by,

Checked by,

Approved by,

15-01-2025

( Gita Siti )

15-01-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )