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.: 002/WEB/I/2026
Phone
PIC
Invoice No. :
PO
Quality Order
Product : HVS ROLL
Quality Complaint
Specification : HVS ROLL 70 73 AQNA
Problem :
-FLUI -CORE KENDOR
Kategory of Complaint
Quality
Handling
Packaging
Quantity
Delivery
Claim value (IDR/USD/SGD/EUR) :
Rp.16.885.680
In Words
(
Enambelas juta delapan ratus delapan puluh lima ribu enam ratus delapan puluh 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 213983951 489,44 FLUI 213750479 489,44 FLUI 213984044 489.44 CORE KENDOR 213983951 : PO/25/0475 : 5782332386 213750479 : PO/24/2216 : 5782252533 213984044 : PO/25/0475 : 5782332388 CAKRAWALA MEGA INDAH, PT
Jakarta, 14 Januari 2026
Prepared by,
Checked by,
Approved by,
14-01-2026
( Gita Siti )
14-01-2026
( Maurina Gurning )
( ........................ )
( Staff Pembelian )
( Ka. Bag. Pembelian )
( Supplier )
Link Verifikasi Vendor :
Copy
LAMPIRAN USER
WhatsApp Image 2026-01-14 at 08.35.25.jpeg
WhatsApp Image 2026-01-14 at 08.35.50.jpeg
WhatsApp Image 2026-01-14 at 08.39.38.jpeg
WhatsApp Image 2026-01-14 at 08.39.51.jpeg
LAMPIRAN PCH
Catatan
Rp.16.885.680
LAMPIRAN AKT
002 Klaim CMI.pdf
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