GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 018/WEB/VIII/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 70 73 AQNA

Problem :

-PENYOK AKIBAT BENTURAN

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp.5.628.560.-

In Words

( Lima juta enam rtus duapuluh delapan ribu lima ratus enam 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
300780524	489.44	PENYOK

NO.DO	5782272763

Jakarta, 12 Agustus 2025

Prepared by,

Checked by,

Approved by,

12-08-2025

( Gita Siti )

12-08-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )