SPECIAL CASE APPROVAL FORM

This form can be used as a Customer Complaint Form

Record No. Date of Claim Case ID or
Trans Rec No
Customer Detail Receiving claim: Category:

Customer TPM ID ACSP SOLO ☐ walk in cust. ☐ Unit & tech

Name JL. MAJAPAHIT VI NO 10 NAYU BARAT NUSUKAN service
Or contact ☐ newspaper ☐ sales &
person
BANJARSARI SOLO 57135
spare part
Phone 0271-729911 ☐ email ☐ Other
Email ACSPSOLO@SDARDJAYA.COM ☐ fax
☐ phone
Detail of Claim/Special case :

 Part Number : NB.G8011.007

 PO Number : PIDABK90158
 Ship Date : 13-Apr-19
 Packlist Number : AINL114491ID
 AWB Number : 190404350000554
 PO pembelian SDM/004/003 diproses menggunakan PO PIDABK90158
 NB.G8011.007 ketika good part d iterima dan dilakukan running test hasilnya MAINBOARD
SYSTEM UNSTABLE
 Oleh karena itu MB dari PO tersebut akan direturn kembali ke ACER menggunakan no DSO
(UNUSED) dan mohon agar dikirimkan MAINBOARD penggantinya. Agar
nantinya fisik MAINBOARD tidak masuk dilokasi good maka diperlukan form eskalasi untuk
approved dilakukannya RC to RC di lokasi warehouse.

Issued by : Screnner Date : Signature :

Escalate to : Analysis / Recommendation given :

1 escalation :
st

Name :
Sign.
Date.
escalation :
2nd

Name :
Sign.
Date.

3rd escalation :
Name :
Sign.
Date.

Action taken :
Please specify :

1.

ACTION CATEGORY ☐ replacement ☐

trade in
☐ discount ☐ others, please specify
……………………………………………
Fulfill by SPD (MANDATORY) :
1 Transferred
st From Location To
: Location
Transaction Nomor
Name Signature Date

2 Transferred
nd From Location To
: Location
Transaction Nomor
Name Signature Date

3 Transferred
rd From Location To
: Location
Transaction Nomor
Name Signature Date

The above final action required has been completed by Acknowledged by Management
Representative
Name Signature Date Name Signature Date