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.: 009/WRH/XI/2025
Phone
PIC
Invoice No. :
PO
Quality Order
Product : HVS ROLL
Quality Complaint
Specification : HVS ROLL 70 88 AQNA
Problem :
BERAT TIMBANGAN KURANG TIDAK SESUAI LABEL
Kategory of Complaint
Quality
Handling
Packaging
Quantity
Delivery
Claim value (IDR/USD/SGD/EUR) :
Rp.50.285.000.-
In Words
(
Lima puluh juta dua ratus delapan puluh lima ribu 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' RUSAK 214003809 592.37 HASIL TIMBANG 576.20 214192540 592.37 HASIL TIMBANG 582.20 214192538 592.37 HASIL TIMBANG 582.60 244192352 592.37 HASIL TIMBANG 576 214003317 592.37 HASIL TIMBANG 576 214003960 592.37 HASIL TIMBANG 576 214003293 592.37 HASIL TIMBANG 588.80 214003171 592.37 HASIL TIMBANG 589.80 214003196 592.37 HASIL TIMBANG 590.20 214003355 592.37 HASIL TIMBANG 590.20 NO. PO PO/25/2171 NO.DO 5782331001
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 70 88 AQNA ( 22-11-2025 ).pdf
LAMPIRAN PCH
Catatan
Rp.50.285.000.-
LAMPIRAN AKT
029 Klaim CMI.pdf
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