GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Media Usaha Grafika

Complaint No. :

Address

CIF No.: 001/WRH/II/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS ROLL

Quality Complaint

Specification : HVS ROLL 70 86 ASPEK BRIGHTNESS 72%

Problem :

-FLUI

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp.6.980.539,43

In Words

( Enam juta sembilan ratus delapan puluh ribu lima ratus tiga puluh sembilan rupiah koma empat tiga )

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 ROLL 403223341432
NO DO	000139

Jakarta, 14 Februari 2025

Prepared by,

Checked by,

Approved by,

14-02-2025

( Gita Siti )

14-02-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )

PT Gelora Aksara Pratama