GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 009/WEB/VI/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 70 73 AQNA

Problem :

MASALAH SAMBUNGAN KERTAS, KERTAS LARI

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 16.953.300

In Words

( enam belas juta sembilan ratus lima puluh tiga ribu tiga 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 :

213903226	491.40	SAMBUNGAN PABRIK
213902388	491.40	KERTAS LARI
213902139	491.40	KERTAS LARI
 NO DN 5782269395 ,5782272435,5782272435

Jakarta, 23 Juni 2025

Prepared by,

Checked by,

Approved by,

23-06-2025

( Gita Siti )

23-06-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )