GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Heidelberg Indonesia

Complaint No. :

Address

CIF No.: 001/CSG/III/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : TINTA PROSES SHEET

Quality Complaint

Specification : INKS SHAPIRA UN SPEED 450MAGENTA @2,5 KG

Problem :

TINTA TERLALU LENGKET/KERAS

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 :

NO. PO	PO/24/2392		NO.DO	1765765569
HEIDELBERG INDONESIA, PT PRN/25/0723

Jakarta, 12 Maret 2025

Prepared by,

Checked by,

Approved by,

12-03-2025

( Gita Siti )

12-03-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )