GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 014/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

Claim value (IDR/USD/SGD/EUR) :
Rp. 11.301.970.-

In Words

( Sebelas Juta tiga ratus satu ribu sembilan ratus tujuh puluh 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
300781009	491.39 KG	CORE KENDOR
30078114	491.39 KG	CORE KENDOR
NO.DO	5782272767

Jakarta, 25 Juni 2025

Prepared by,

Checked by,

Approved by,

25-06-2025

( Gita Siti )

25-06-2025

( Maurina Gurning )

10-07-2025

( Oscar )

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )