GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

RAJA CEPAT NUSANTARA

Complaint No. :

Address

CIF No.: 004/WRH/VII/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : 540 PACK

Quality Complaint

Specification : ( BUKU TULIS SMART CAMPUS PRM 42 )

Problem :

KIRIMAN SUMA KE SURABAYA SAMPAI SAAT INI BELUM SAMPAI ( INFO DARI TIM RACE )

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 :

NO. KENDARAAN = B 8167 OS, NO.DO	= RCC6425-02201

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 )