GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Heidelberg Indonesia

Complaint No. :

Address

CIF No.: 003/TEK/VIII/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : 2 Pcs

Quality Complaint

Specification : SENSOR OPT RS PROX (ET-KIT)P/N : F2.110.1463

Problem :

SPAREPART SENSOR OPT RS PROX (ET-KIT)P/N : F2.110.1463 YANG DIKIRIM DARI VENDOR HEIDELBERG TIDAK SESUAI, SEHINGGA TIDAK BISA DIPASANG DI MESIN

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 :

Jakarta, 11 Agustus 2025

Prepared by,

Checked by,

Approved by,

11-08-2025

( Lan Hermes Sinaga )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )