GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 004/CSG/IX/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS SHEET

Quality Complaint

Specification : HVS 70 65X88 RAP PRM

Problem :

-FLUI

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp.2.259.075

In Words

( Dua juta dua ratus lima puluh sembilan ribu tujuh puluh lima 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 :

NO.DO	SJ25030/12688
        KERTAS BELUM TERCETAK UK' TO/MRN(PLANO)	:	9.10 RIM

Jakarta, 07 Oktober 2025

Prepared by,

Checked by,

Approved by,

07-10-2025

( Gita Siti )

07-10-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )