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.: 008/WRH/XI/2025
Phone
PIC
Invoice No. :
PO
Quality Order
Product : HVS ROLL
Quality Complaint
Specification : HVS ROLL 70 73 AQNA
Problem :
BERAT TIMBANGAN KURANG TIDAK SESUAI LABEL
Kategory of Complaint
Quality
Handling
Packaging
Quantity
Delivery
Claim value (IDR/USD/SGD/EUR) :
Rp.379.500.000.-
In Words
(
Tiga ratus tujuh puluh sembilan ribu lima ratus 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 HASIL TIMBANG 300811142 491.39 HASIL TIMBANG 448 300811140 491.39 HASIL TIMBANG 454 300780818 491.39 HASIL TIMBANG 456.6 300780815 491.39 HASIL TIMBANG 472.6 213902754 491.39 HASIL TIMBANG 474 213902908 491.39 HASIL TIMBANG 475.8 300781110 491.39 HASIL TIMBANG 479.2 213855496 491.39 HASIL TIMBANG 480.6 213855527 491.39 HASIL TIMBANG 481.4 213902696 491.39 HASIL TIMBANG 482 NO. PO PO/25/0475 NO.DO 5782335035
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 73 AQNA ( 22-11-2025 ).pdf
LAMPIRAN PCH
Catatan
Rp.379.500.000.-
LAMPIRAN AKT
029 Klaim CMI.pdf
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