FORM No.11 (See Rules 62 and 64) (Report of examination of hoist, lif, lifting machine, chains, ropes and lifting tackles ) 1) Name of occupier of Factory 2) Adres of the Factory 3) al Type Identification number and description of hoist, lif, iting machine, chains, ropes and lifting tackles. ‘Date of construction or reconstruction and the dete when the hoist, lif lifting machine, chains, ropes and lifting tackles were first taken into use in 4) Date of cach last examinations made under Section 28 (1) (a) (li) and 29 (1) (a) (ii) and by whom it was carried out. 5) (A) Maintenance: List of pats, if any, which were inaccessible) Are the folowing parts of the hoist orl properly maintainod nn good orking order? It, sate what defects have ben found» (@)_ Enclosure ofoistway or litway. (©) Landing gates and cage gate (9) (©) Incrochs onthe landing gies and cage gat () @ —G obhergues tastenines (©) Cageand platform and fnings, cape guides, balers, intror ofthe boitway or litway (©. Overruming devices (6) Suspension ropes or chains and her atachments (h)_ Safety gear, ie, arrangement for preventing fll of platform or cage brakes. (Brakes G) Work of spur gearing. (8) Other electrical equipment. (Other pars 'B] Date and number ofthe cenificate relating to any test and examination Made under sub-rule (1) of rule 64 together with the name ofthe person ‘iho issued the cenificate. Ii) Date of anncaling or ther heat treatment of the chain and lifting tackle caried out under sub-rule (5) of rule 64 and by whom it was eartied out, (Paiculars of any defet found at any such © Examination or flr annealing and affecting the safe working load and ofthe steps taken toremedy such defect ) Repairs, renewals o altrations (if any required and the period within Which they should be executed and maximum safe working lad subject to ‘repairs, renewals or altemations (if any) We cestfy that on dt. 21.0 ‘of examinations/test carried out is enclosed herewith thatthe above Next Due :20,012023005 HIGH TECH CONSULTANCY Jai Ganesh Vision, A.Wing 311, ‘Akurdi pune ~ 411033, 020-27440344 Scnail-pnkulkarni 19614 rediffmail.com s-muilchteapk}2@remail eam ‘AN 1S0 9001:2008 CERTIFIED COMPANY 1.2022 1 We thoroughly examined the hoist, i, lifting machine, ‘correct report ofthe result. : Mis. GURUDATTA CRANE SERVICE. + Ranjangaon Ganpati, Near Old Plaza, Pane Noga Rood, Tt Sin DisePune, Magellelsig— Working Helght 45 Feet Capacity 230 kg. ‘Year - 2020 2 Asper factory record NA, NA. NAL NA. 2 NAL DNA NAL NAL NA. NA. PNA 2401,2022)by P.N.Kulkarni + Not Applicable, + Lifting Equipment is use under SWL only, 230 Kg, + Found OK. ‘ropes and lifting tackles and details Pt Rate 1D. Es (Mech) MBA, Ex. Scletist BARC, =. Chanered Engineer Scanned with CamScanner2 CONTRACTOR'S PLANT AND MACHINERY INSURANCE POLICY beret ae Sag Die Dae aio soso ota Goan aancasSsunancE bo Tae fe eat no es RPE ;aGAR—|aamse Isr users, 11 tiooe SAS iON Sea a ANGLES ROsb,Pote PUNE sears, 100 eat. 2 [Phone No 7 f2611 1042 26111043 seine i eooinee “JaastogevenconT sasney Pane ; Scrape naacustescSTia : sae Joos oer onions ez cs Poi Detl Paley Naber [scan Sansa Sours Ede Period of Insurance +] DIRECT BUSINESS - (107802646) Dam at rapa floezz cet ears |) RY ND AL aeRO SESE sos |Prev. Policy no. 15030044190700002542 |Phone No_ 19850091819 / NA. clon Type Non carota athe v7 Fria oar Toa Tarot Aba ry Sar ‘iat “tho aT eee Toeatonat Option [Locations of Operation [Risk Aadrese: 1 SHIRUR, NA, Ranjangaon Ganapat, MAHARASHTRA, INDIA, 419200 Tam | Gamaty | ‘eoatgion ios Biome doo Creme waz [ome] peattoagieare ‘ise! obi Selon me ene 71} Wadine Beeston? | — eo | —prensoo | —a —} “ran kta sie Race saa er ae, Sbocthet a voc 6° terion. ne % OP ik eee a a feattan awed raTeos00 Sit “Aad on Coven Oped Tademnly Unis Oped os ‘ THR PARTY DABRIT 0st ey Ene 2 | BRPRESS ERcIonT (exctuolNG ARFREGHD tA Paley Esces SS Rena oN Ae z TAR FREIGHT 7a Sarg t TADDTIONA LeUsTous DUTY mn Tet Adan aay n SUBROUNONG PROPERTY 708 Poley Exess Team Exess Tol Son aed suDBC nan 1.00000 rath andy aim Sar Policy No. : 18030044190900001458 Document generated by 38480 at 21/01/2022 16:66:50 Hours. Rogd. & Head Office: New India Assurance Bldg, 87 M.G. Road, Fort, Mumbal - 400 001, TOLL FREE No. 1 800 209 1415. Scanned with CamScanner