GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 003/CSG/VIII/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : HVS SHEET

Quality Complaint

Specification : HVS 70 65X88 RAP PRM

Problem :

-FLUI

Kategory of Complaint

Claim value (IDR/USD/SGD/EUR) :
Rp. 4.592.625.-

In Words

( Empat juta limaratus sembilan puluh dua ribu enam ratus duapuluh lima 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	SJ25013/10671
KERTAS BELUM TERCETAK UK' SUDAH TERPOTONG = 62,6 X 87,6 CM	:	18,5 RIM

Jakarta, 20 Agustus 2025

Prepared by,

Checked by,

Approved by,

20-08-2025

( Gita Siti )

20-08-2025

( Maurina Gurning )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )

PT Gelora Aksara Pratama