GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 016/WEB/VII/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : KERTAS ROLL

Quality Complaint

Specification : HVS ROLL 70 82 PAPER PINDOPLUS

Problem :

-CORE KENDOR

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 6.456.000

In Words

( Enam juta empat ratus lima puluh enam ribu 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 = 082506158P	QTY = 538 KG	KET' RUSAK = CORE KENDOR
NO.DO =	D1L0081463

Jakarta, 26 Juli 2025

Prepared by,

Checked by,

Approved by,

26-07-2025

( Nurul )

26-07-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )