GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 005/SHT/VIII/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS SHEET

Quality Complaint

Specification : HVS 70 GR 65 X 88 RAP

Problem :

-FLUI

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 27.769.245

In Words

( Dua puluh tujuh juta enam puluh sembilan ribi dua ratus empat 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	SJ25030/11325
KERTAS BELUM TERCETAK UK' TO/MRN(PLANO)		:	101,62 RIM
KERTAS BELUM TERCETAK UK' SUDAH TERPOTONG X	:	  10,24 RI

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 )