FORM 11

(Soo Ruos 62 ond 04)

Machlne, Chains, Ropos and LIting Tacklos
Roport of Exnmination of Hoist, Lift, Lufting ISSJDE-22631]
M/a. JB Entorprioo
Namo of the Occupler
201, Kundalini, Konditn Rood. Andhan (Eanl),
2 Namo and nddrass of Uhe factory
Mumbal-400059

of 50 Ton Capacty, Polyoutor Round Endlono Sug. Color

(a) Typa kdentilcation numbar and doscription Mako: NKKA
and Orango, Circumlorontial Longlh: 7.5 mtn.,
holst, lu, lining machine, chnins, ropos
liting tocklos
Sr.No.: 22631,

(b) Date of constuction or econstrudtion and the 26.02 2022

dato whan the hotst iN, lufung mochino,
chains,
tocklos were first laken into
ropes and lifting
Use in tho foctory.

Date of last examinations mode under section Not Applicable

28{1) (a) (i) and 29 (1) (0) (m) ond by whom
was camied out

5 (A) Maintenance (List of parts, if any which were

inaccessible) Are the following parts of tho holst of

uft propety maintained and in good working order?
if not. state whal defects have been found
(a) Enclosure of hoisway or liftway. Not Applicable.
(b) Landing gates and cage gate(s) :NolApplicable
(c) Interlocks on he landing gates coge gate(s) :NotApplicablo
(d) Other gotes fastenings. :NotApplicablo
(e) Cage and plotorm and fitings, coge guides, :NotApplicable
Buffers, intenor of the hoisway or lifway
() Ovemunning devices Not Appicable
O.
9) Suspension ropes or chains and their attachments
fall Not Applicoble
() Safety gear Lo. orongements for proventing
Of plotfom or cage brakes
Brakes
Not Applicablo
Work of spur gearing Not Applicablo
0 Not Applicable
(K) Other olectical cquipment
O.K
() Other parts
(B) Date and number of Certificate relatng to ony 26.02 2022 By Industnal Safoty Sorvices
test and examination made under sub-rule (1)
of rule 84 together with the name of the person
who issued the cenuficate
or the heat ueatment ol the Not Applicable
(C) () Dato of onnealing
chain and lifing tackle carned out under sub-
ule (5) of the nule 64 and by whom it was
camed out
()Particulars of any defect found at any such : Not Applicable
exomination or after annealing and offecting
he safe working load and of the steps tokan
lo remedy such defect

Repairs, renewals or alterations (if any) required and Nil.

the period wilhin wthich hey should be executed and Examined And Found sulloble for SWL 50 Ton
maamum safe working load Bubjet to repairs. Examinaton Camed out at our works
renewalsor allerauons ( any)
1/We cetily thal on 26.02.2022 1/ We thoroughly exomined the holst. i t Iinung machuno, ropos and liNing
Lackles and detalls of exam1nations / test carmed out is enclosed herewith thot tho above is a coToct roport of tho rosult

Signature Counter Signaturo

AMOL B. PARIKH If amployed by a company or ussodintion.
BE(ELECTRUCAL)
RIALSAFETY SS Give nomo and addro8s.
INDUSTRUAL SAFETY SERVICEs
Qualiflication ADVANCE DIPLOMA
(INDUSTRIAL SAFET THANE
2 Sujato Induatrial Eotato, Ground Moor,.
Noar Makhmali Taluo, THANE400 601
Address Indusurial Suloty Services Tal No 25342373 / 25345261/ 2634 1077
Sujuta induallal Esluu E-mal:nmaipaikh1077Kdamallam
Date Noorlbabu Rond. OAgro Road,
CPC NO MS/DISHICPC/P048/2020
Huar Auklvnull Talao. TIANE 400601 VALID FROM 01/01/2020 TO 31/12/2022

NEXT DUE DATE:25-02-2023

 FORM I
(Soo Rulon 62 ond 64)
and Lifting Tackles
Raport of Examinotion of Holot, Lift, Lifüng Machino, Chains, Ropes
ISS/JBE-22632
Numo of ho M/o JB Entarprise
Occupio
201, Kundnlini, Kondivitn Road. Andhorn (Enot),
Nanmo and addrono of tho faatory
Mumbal-400069

Color
ldontilcalion numbor and doncriplion of 60 Ton Copocity, Polyontar Round Endleso Sling,
(o) Typo Ciraumforanual Longth: 7.6 mto., Mnke: INKKA
hoiut, lin, uting muhino, chninn, ropao and Orungo,
Sr.No 22632,
lUNing taaklon.

und tho 26.02.2022

(b) Dato ol oonntnuation or roconutruation
duta wlion tho holnt, Ii1, ifung machino, choins,
opon ond lifing toaklou woro Nrol tnkon Into
Uno in tho fnatory

Duto of lanl oxaminaliono mndo undor soction Not Applicablo

20(1) (o) (U) and 20 (1) (n) (ul) and by whom
Win dariod oul

(A) Maintananco (LUot of partn, If ony which woro

6
Inaccouulblo) Aro tho following parto of Uho hoint of
lin proporly maintuinod and In pood working ordor?
f nol, otnto whut doloalo hovo boon Iound
(n) Enalonuro of holntwny or inwny. Not Applicoble
(b) Londing galun and cugo goto(o) Nol Applicoble
(o) Inlortlooko on tho londing gntoo & ango gnto(8) Not Applicable
(d) Ohor ootun fontoningo Nol Applicoble
(o) Cog0 and plntform ond fiingo, cago guideo, Not Appllaoble
Bulfaro, intanor of tho hoiatway orlftwny
(0 Ovorunning dovicos Not Applicoblo
Sunpongion ropuu or chuino ond thoir oltachmanta OK
(o)
Nol Applicable
(h) Saloly gonr lo. orangomonto for provonling foll
Of plalfom or coFo brakoo
Brukou Nol Applicable
Work of upur gouinO Not Applicable
)
(k) Olhor oloatrical oquipmont Not Applicable
(0) Ollhar parto O.K

(B) Dnto and numbor of Corlflcato rolating to any 26.02 2022 By Induntrlal Salety Services
toot ond oxuminolon mudo undor sub-rulo (1)
of rulo 64 togother with the nomo of tho porBon
who iuouad tho cortilicato
(C) () Duto of annouling or tho houl troatment of th Not Applicable
ahoin ond liung tockle carried out undor oub-
rulo (5) of ulha rule 84 and by whom It woo
Curnod ouL
() Pornioularu of any doloct found at any suah Not Appltcable
Oxminatlon or oler onnonlng and affaating
tho oafo working load ond of Uhe stopa tnkon
to remody vuch dofeot

Ropalro, ranowalo or altoratlono (if any) requlrod and Nil.

ho porlod within wuch thay ghould be oxecuted and Examined And Found suilable for SWL 50 Ton
maximun anlo working lond oubjoct to ropairs, Exominolilon Corried oul at our vworks
ronuwals oraltorutiong(f any)
/Wo cortily that on 26.02.2022 1/We thoroughly examned the holat, lif, lifting machine, ropes and lifing
tncklon and dotailu of auminationo/ lest carried oul is enclosed herawth that the above io a correct report ofthe resull

Signnluro Countor Signoture.

AMOL B. PARIKH If amployed by a company or associotion,
BE(ELECTRIOAL) SAFE S Glve nome and oddresa
Qunlillcation

Addrooo
ADVANCE DIPLOMA
(INDUBTRUAL AFETY)

Induniral Saloty Servlceo

THANE
SER INDUSTRAL SAFETY SERVICES
Sujnta Industnal Estale, Ground Floor,
Near Mokhmoli Toloo, THANE-400 601
Tol.No 26342373/25345261/25341077
Bujntn Ind»stlal Entat E-mail moinnikh1977(damal com
Dnto Noobato Roud, On Agro Rond,
Nour Muklunall Taluo.THwNE400U01
CPC NO MS/DISHUCPCP-048/2020
VALID FROM 01/01/2020 TO 31/12/2022

NEXT DUE DATE:25-02-2023

 FORM I
(S0o Rulon 62 and 84)
and Lifting Tackles
Roport of Examinaton of Holst, Lifn, Lifting Machlne, Chains, Ropes
IsS/JBL-226321
Nuno of ho Occupior M/o. JO Entarprino

201, Kundnlini, Kondivito Rood. Andhon (Eoot),

Nonio and nddrono of tho faatory
Mumbal-400069

Color
ldontilcalion numbor and doncripllon of 60 Ton Copocity, Polyontar Round Endleso Sling,
(0) Typo Ciraumforanial Longth: 7.6 mto., Mnke: INKKA
hoiut, lin, luing miudlino, ahuninn, ropao and Orungo,
Sr.No 22632.
uing toaklon.

und tho 26.02.2022

(D) Dato of conntruation or roconntruatlon
duto whon tho hoiut, in, iun0 machino, choins,
ropon and lifing toaklou wora îrot tnkon Into
uno in tho fnatory

Duto of lanl oxaminaliono mndo undor Boction Not Applicoblo

20(1) (o) (U) ond 20 (1) (o) (i) and by whom I

win ourriod oul

(A) Maintananco (LUul of partn, If ony wthich woro

6
Inadcouuiblo) Aro tho following parto of Uho hoint of
in proporly maintuinod and In good working ordor?
il nol, otnto whot doloato havo boon found
(n) Enalonuro of holntwoy or inwny. Not Applicoble
(b) Londing oatuo and cugo goto(o) Nol Applicoble
(o) Inlorlooko on tho londing gntoo & ango gnto(o) Not Applicoble
(d) Oilhor gatoo footoningo Nol Applicoble
(0) Cag0 and plntform ond iungo, cogo guideo, Not Appllaoble
Bulfer, intonor of tho holutway or lftwny
(0 Ovorunning dovicos Not Applcoblo
Sunponuion ropeu clhuino ond thoir altachments OK
(o) or
arrongomonto lor provonung foll Nol Appicable
(h) Saloly gonr lo.
Ot plulform or cogo brokao
(0 Brakou Not Applicoble
Work of upur gouing Not Applicable
)
(k) Olhor oloatrical oquipmont Not Applicoble
() Olhor parto O.K

(B) Dnto and numb0r of Corliflcalo rolating to any 28.02.2022 By Induotrlal Safety Services
losl ond oxuninotion mndo undor oub-rule (1)
of rulo 64 togothor wilh the nomo of tho porson
who isouad tho cortilicato
(C) (1) Dulo of annouling or tho hoal troatmont of the Not Applicable
ahoin ond lifung tockle caried out undor oub-
rulo (5) of ulha rulo 84 and by whom It woo
camod out
(i) Pornioularu of any dofoct found at any suah Nol Applicable
Oxminallon or oler annonlng and affaaling
tho oofo working lond ond of Uhe stopo tnkon
to remody ouch dofeol

Ropalro, ranowalo or altorationo (1 any) requirod and NII.

ho porlod within wuch thay ghould be oxecuted and Examined And Found suilable for SWL 50 Ton
maximurn onfo working load oubjact to ropairs, Examinotlon Caied oul at our works
ronewalooraltorntiond (if any)
/Wo cartily that on 26.02.2022 1/We thoroughly examned the hoat, lif, lifting machine, ropes and liftng
tncklon and dotalu of axominaliono/ lost carried oul is onclosed herawith that ho above io a correct report ofthe resul

Signalur0 Countor Signature.

AMOL B. PARIKH If amployed by a compony or associoton,

Qunlllcation
BE(ELECTRIOAL)
ADVANCE DIPLOMA
(INDUBTRIAL BNFETY
Addrooo Indunlnal Saloty Serviceo
Bujata Indust1lal Eulal
Dato Nooribaba Rond, Om Agro Rond,
Noar Muhunall Talao.TiwE400W01
RAL
SAFE Y SE Givo nome and oddress
INDUSTRAL SAFETY SERVICES
Sujnta Industnal Enlate, Ground Floor,
THANE Neor Makthmall Toloo, THANE-400 601
Tol.No 26342373/25345261/25341077
E-mn molpntikh1977aanal com
CPC NO MS/DISHUCPCIP-048/2020
VALID FROM 0101/2020 TO 31/12/2022

NEXT DUE DATE:25-02-2023

 FORM
(800 Rulan 02 and 04)
Tacklo0
eport of Examalton ot Holut, Lin, Liting Machno, Chalno, Ropou and Lifing
INN/J-226.1M
Nama of uho Ocoupoe At/a J tilotprino
201, Kundaln, Kondivin Rond, Andhori (Eiant)
Naurva and akhwun of tho laotoy
Mumbaln 400000

60 Ton Gapaany, Polyuntor Round

Gndloun Shp, Color
(a) TYNo Klnutoaten numbor and douanption of Mako: INKKA
homt, o0, itng nmuaohno, onainn, topuu and Ongo, Ciounlorvnlinl Long 70 mio,
N o 22034,
Itng tnokkon

(b) uto ol onnnuvation or maonntruation and tho 20.0 2022

cnto whon Uho holut. lun, tutung muuhuno, alvunn,
(Opoa and lfMiung ladklon woro Int tukon nto
iho ln th fivotory

(uta of lanul ovuminuliona maddo undor uation No1 Applionblo

) ( a ) 1) 4anned 90 (1) (a) (0) und by whom I
wD Onxd out

A Alaintonanco (Liut of paitn, Il ony wihiah wuro

naoowauitlo) Ainy lto follown0 paitn of lho hout o
toN proporly muntunod and n (qootd woikino ortdor?
If not, nlutw whal tlohxitn havo boun found
(a) tnoouuw of homdvay or Mwaay Not ApphQnblo
() Lanina quha and oago oto(n) Not Applionblo
(0) Intuilooku on tho lunclino oaton & ongo onlu(n) Nol Applioublo
(t) Olhor gudoa tautonngu Nol Appliuablo
(0) Cag) and plulfoin und hlingn, daga gunlon, Nol Applionblo
tulao, nteioi ol tho hoinhvay or lihviny
(0 Ovnimng chovloo
Not Applonblo
or olhatnn and tholr altaolunontn OK
(7) unonuion ropon
lo tangononlu for provonling fal
NoI Applonblo
()Suloly gour
Ot lutoni of oopo biuukon
(0 Brahou Not Applionblo
WoiA of bpui gonun0 Nol Applioablo
Ohur al0olnonl oquipnonn Nol Appllonblo
OK
() Olhai purto
((0) Duto und numdNI ol Coithouto rulaling to any 20.02 2022 0y tnduntrnl Suloty Survicon
toul and oxnnavon mado undor wub-eulo (1)
ol ulo 04 logolhot wilh tUho nnno of ho pornon
who luvuod tho corthoato
or tho hout tvubnont of Uho Not Apphoatblo
(C) (1) Datu ot annouling
Ohuin ond liung taoklo ouriod oul undor oub.
ulo (8) afl tha nulo 04 (und by wlhom l wa
onniod oul
al any nuoh
(11) Partiaulnin of any dufoat found Nol Applloublo
(Ninalion of anur annoulng and alloalino
ho balo WOiking lond and of Uho utop tokon
to tunndy nuoh doloot

Rapin, onowaln or altorutionn (1l any) roquwod and NI

Iho ponod wllun wlioh thoy olhould bo OxOOutod and Exnnnod And Found vunnblo for 9Wl. 50 Ton
nmxnunm nalo working loud nubjoot lo rupilro, Exnminatuon Coriod out at our worko
twnowun or ultoralhonu(lany)
/Wo certily thul on 26.02,2022 /Wo thoroughily oxuminod tho hotut, in, uing maohno, ropas and iuno
uchloa and dotailn of oxamnntonn / tont onnod out in anulouod horuwth thuat tho abovo in a corroot roport of tho ronull

Slgnawo Countor Blgnuluro.

AMOL B. PARIKH If anployad by a compuny or auvodinion,
uaTICAL) RAL9AFETY dlvo nnnu ind oddroon
Qualihoalon ADVANCU DI'LONA
(INDUNTNAL AUIYn
THANE
SER INDUBTRIAL 8AFLTY 8URVIQG8
Sujnta Induulrmt Entalo, Oround Floor
Nour Malthnall Talno, THANE-400 001
Adurons tnduntnal ufoty Borvioon Tol No 203A2373/ 20348201/2034 1077
figuto luautud Uututo
NoWba vao On Ay1n flond.
EFnnll nopmdu19TIGRnt.Cor
Dulo
CPC NO MS/DIBWOPCP-048/2020
Nnai Atuaunan loluo. NANU 400001
VALID VROM O1018020 TO 01/12/2022

NEXTOUE DATE:25-02-2023