GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 013/WEB/VI/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 70 73 AQNA

Problem :

-CORE KENDOR

Kategory of Complaint

Quality	Handling
Packaging	Quantity
Delivery

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 :

NOMOR ID ROLL	QTY	KET' RUSAK
213902656	491.40	CORE KENDOR
300780713	491.40	CORE KENDOR
300780633	491.40	CORE KENDOR

NO.DO	5782269395,5782272762,5782272762

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 )