FORM B

MINISTRY OF MANPOWER, SINGAPORE LE Registration No. : LG939012

WORKPLACE SAFETY AND HEALTH ACT 2006 UEN of Owner. : 201407064M
WORKPLACE SAFETY AND HEALTH (REGISTRATION AND OTHER Workplace No. :
SERVICES FEES AND FORMS) REGULATIONS
CERTIFICATE OF TEST/THOROUGH VISUAL EXAMINATION OF
LIFTING EQUIPMENT (LE)*

Owner of Lifting Equipment Factory Occupier and Location of Lifting Equipment

AMPELMANN ASIA PACIFIC PTE LTD USED AT VARIOUS SITES.

56 TRAS STREET, #02-00
SINGAPORE 078995.

Particulars of Lifting Equipment

Type and Description LIFTING GEAR: Classification Code :
of Lifting Equipment
ENDLESS ROUND SLING 2.4 MTR.
QTY: 1 LENGTH.

Brand Name : UNKNOWN Distinctive No. ** : AMP 1407

Country of Origin : UNKNOWN Date of Manufacture : UNKNOWN
Source of Power : MANUAL First Registration Date : UNKNOWN
Max. Safe Working Load : 15000 KG. Max. Boom Length/Span :
Owners’ : Length of Fly :
Reference/Vehicle Jib/Extension
Registration No.

Particulars of Last Load Test

Date of Load Test : 17/03/2017 Max Test Load : 30000 KG
(1) (2) (3) (4) (5) (6)
Radius (m) :
Test Load (kg) :
Safe Working Load (kg)

Comments/Observations

P.I.D. : 1349393-18 / APPELMANN

ALWAYS CHECK THE LIFTING GEAR/APPLIANCES CONDITION PRIOR USE.
TO ENSURE MAINTENANCE AND SAFE OPERATION OF ABOVE LIFTING GEAR/APPLIANCES.

I certify that on 17/03/2017 the lifting equipment described in this certificate was examined thoroughly by me, as far as
its construction permits, and this is a true report of my examinations.

I further certify that the lifting equipment complies in all respects with the requirements pertaining to lifting equipment as
stipulated in the Workplace Safety and Health (General Provisions) Regulations, and all other regulations made
thereunder and is safe for use.

Expiry Date of Date of Print of

Authorised Examiner’s Name Signature of Authorised Examiner
Certification Certificate

LEONG YEU HUN

16/03/2018 20/03/2017

* Lifting Equipment means Lifting Gear, Lifting Appliance, Lifting Machine, Lift and Hoist as defined under the Workplace Safety and Health (General Provisions)
Regulations.
** Distinctive Number refers to the Identification Number/Serial Number assigned to the equipment by the manufacturer.