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.: 007/WRH/XI/2025
Phone
PIC
Invoice No. :
PO
Quality Order
Product : HVS ROLL
Quality Complaint
Specification : HVS ROLL 58 86 AQNA
Problem :
BERAT TIMBANGAN KURANG TIDAK SESUAI LABEL
Kategory of Complaint
Quality
Handling
Packaging
Quantity
Delivery
Claim value (IDR/USD/SGD/EUR) :
Rp.38.698.800.-
In Words
(
Tiga puluh delapan juta enam ratus sembilan puluh delapan ribu delapan 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 HASIL TIMBANG 300899292 577,47 HASIL TIMBANG 557 300899851 577,47 HASIL TIMBANG 559.40 300899590 577,47 HASIL TIMBANG 563.40 300899293 577,47 HASIL TIMBANG 565.40 300899599 577,47 HASIL TIMBANG 566.80 300899852 577,47 HASIL TIMBANG 567 300899282 577,47 HASIL TIMBANG 569.40 300899850 577,47 HASIL TIMBANG 570.80 300899595 577,47 HASIL TIMBANG 571.40 300898911 577,47 HASIL TIMBANG 572.80 NO. PO PO/25/1752 NO.DO 5782335041
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 86 AQNA ( 25-11-2025 ).pdf
LAMPIRAN PCH
Catatan
Rp.38.698.800.-
LAMPIRAN AKT
029 Klaim CMI.pdf
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