PT Gelora Aksara Pratama
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FRM.PCH.04.01/rev-3
PT. GELORA AKSARA PRATAMA
Jl. H. Baping Raya No. 100, Ciracas, Pasar Rebo, Jakarta timur. Telp (021) 8710060. Fax (021) 8710566
COMPLAINT ASSESSMENT FORM
Supplier Name
Cakrawala Mega Indah
Complaint No. :
Address
CIF No.: 010/WRH/XI/2025
Phone
PIC
Invoice No. :
PO
Quality Order
Product : HVS ROLL
Quality Complaint
Specification : HVS ROLL 58 101 AQNA
Problem :
BERAT TIMBANGAN KURANG TIDAK SESUAI LABEL
Kategory of Complaint
Quality
Handling
Packaging
Quantity
Delivery
Claim value (IDR/USD/SGD/EUR) :
Rp.52.181.500.-
In Words
(
Lima puluh dua juta seratus delapan puluh satu ribu lima ratus 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' HASIL TIMBANG 213947527 678.19 HASIL TIMBANG 673.80 213947572 678.19 HASIL TIMBANG 675.40 213947504 678.19 HASIL TIMBANG 668.40 213947476 678.19 HASIL TIMBANG 672.40 213947537 678.19 HASIL TIMBANG 675.20 213947546 678.19 HASIL TIMBANG 671.80 213947547 678.19 HASIL TIMBANG 674.80 213898600 678.19 HASIL TIMBANG 676.40 213947684 678.19 HASIL TIMBANG 670.60 213947707 678.19 HASIL TIMBANG 674 NO. PO PO/25/0188 NO.DO 5782277281
Jakarta, 26 November 2025
Prepared by,
Checked by,
Approved by,
26-11-2025
( Gita Siti )
26-11-2025
( Maurina Gurning )
( ........................ )
( Staff Pembelian )
( Ka. Bag. Pembelian )
( Supplier )
Link Verifikasi Vendor :
Copy
LAMPIRAN USER
HASIL SAMPLING TIMBANG ROLL 58 101 AQNA ( 22-11-2025 ).pdf
LAMPIRAN PCH
Catatan
Rp.52.181.500.-
LAMPIRAN AKT
029 Klaim CMI.pdf
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