GAP Portal

COMPLAINT ASSESSMENT FORM

Supplier Name

Cinjoejaya Perkasamuda

Complaint No. :

Address

CIF No.: 012/SHT/IX/2025

Phone

PIC

Invoice No. :

PO

Quality Order

Product : 25,24

Quality Complaint

Specification : HVS 70 GR 65 X 88 CM RAP

Problem :

FLUI (KERTAS SUDAH TERPOTONG UK. 62,6 X 87,6 CM SEBANYAK 25,24 RIM DAN SUDAH TERCETAK 1 RIM)

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 :

DARI PENGIRIMAN NOMOR :  SJ25015/12453

Jakarta, 22 September 2025

Prepared by,

Checked by,

Approved by,

22-09-2025

( Nurul )

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

( Staff Pembelian )

( Ka. Bag. Pembelian )

( Supplier )

PT Gelora Aksara Pratama