GAP Portal

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 )

PT Gelora Aksara Pratama

Write what You Do, Do what You Write !