GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 001/SHT/I/2026

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS SHEET

Quality Complaint

Specification : HVS 70 GR, 79 X 109 CM RAPPREM

Problem :

KERTAS LEMBAB

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 76.568.970.-

In Words

( Tujuh puluh enam juta lima ratus enam puluh delapan ribu sembilan ratus tujuh 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 :

NO.DO	SJ26013/01131

Jakarta, 29 Januari 2026

Prepared by,

Checked by,

Approved by,

29-01-2026

( Gita Siti )

29-01-2026

( Maurina Gurning )

( ........................ )

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )