GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Aktual Teknik

Complaint No. :

Address

CIF No.: 002/SHT/VI/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : BAHAN PENOLONG

Quality Complaint

Specification : Kain lap majun

Problem :

- Kain lap majun tidak dapat menyerap solvent & minyak tidak baik - Kain lap majun berbahan halus dan licin

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 :

Mohon ditindaklanjuti

Jakarta, 07 Juni 2025

Prepared by,

Checked by,

Approved by,

07-06-2025

( Nurul )

07-06-2025

( Maurina Gurning )

18-06-2025

( Sugeng )

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )