GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Budi Karya Sentosa Sejati

Complaint No. :

Address

CIF No.: 003/SHT/VII/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : 10 RIM

Quality Complaint

Specification : PLASTIK PET 200 MICX 100 X 70 CM

Problem :

SURFACE TENSION KERTASNYA DI BAWAH 38, SEHINGGA TIDAK BAIK UNTUK DI CETAK

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :

In Words

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

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 :

Jakarta, 29 Juli 2025

Prepared by,

Checked by,

Approved by,

29-07-2025

( Nurul )

29-07-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )

PT Gelora Aksara Pratama