GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 007/CSG/IX/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : 14,43 RIM

Quality Complaint

Specification : HVS 70 65X88 RAP PRM

Problem :

-FLUI              (KERTAS SUDAH TERPOTONG UK. 	62,6 X 87,6 CM SEBANYAK 13.28 RIM DAN SUDAH TERCETAK 1.15 RIM)

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 3.582.248.-

In Words

( Tiga juta lima ratus delapan puluh dua ribu dua ratus empat puluh delapan 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 BERDASARKAN SURAT JALAN NOMOR : 	SJ25030/12688

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 )