GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cakrawala Mega Indah

Complaint No. :

Address

CIF No.: 013/SHT/IX/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : 20 RIM

Quality Complaint

Specification : HVS 70 GR, 79 X 109 CM MIRAGE

Problem :

-FLUI               (UKURAN SUDAH TERPOTONG 74,6 X 103,6 SEBANYAK 18 RIM DAN YANG SUDAH TERCETAK 2 RIM)

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 5.384.049.-

In Words

( lima juta tiga ratus delapan pulh empat ribu empat puluh sembilan 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 :

DARI PENGIRIMAN NOMOR SURAT JALAN : 	2150311033

Jakarta, 22 September 2025

Prepared by,

Checked by,

Approved by,

22-09-2025

( Nurul )

24-09-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )