GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 004/WEB/VI/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 70 73 AQNA

Problem :

BERAT FISIK DAN LABEL TIDAK SESUAI

Kategory of Complaint

Quality	Handling
Packaging	Quantity
Delivery

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 :

NOMOR ID ROLL	QTY	         KET
300811399	491.39 KG	FISIK 479.4 ( -11.9 KG )
300811397	491.39 KG	FISIK 484 ( -7.39 KG)
300811419	491.39 KG	FISIK 474.8 ( -16.59)
NO.DO	5782263191

Jakarta, 03 Juni 2025

Prepared by,

Checked by,

Approved by,

03-06-2025

( Gita Siti )

03-06-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )