CERTIFICATE OF THOROUGH EXAMINATION

This Certificate complies with the requirements of the Lifting Operations & Lifting Equipment Regulations 1998

DGAT/FM001 Rev 00 Dated 19Jun2022

Certificate No: DGA-YAS-2022-09-28-001 Report No: 10002
Date of Inspection 28-Sep-2022
Date of Certification 28-Sep-2022 Sticker No: 0052
Customer order No: SPO 2022000207 Name of the Equipment: Fork-Lift
Name and Address of the Owner: Equipment ID: 5630-SAA
Manufacturer Name and Year: Hyster, 2011
Saudi Dutest
Location of Examination: Dutest Workshop
Description of Equipment Safe working Load (SWL) Proof Load
Identification Number This should include size, grade and any other particular type Quantity of each Item / Capacity Applied
(Specify Units) (Each item)
(i) (ii) (iii) (iv)
(v)

Fork-Lift Model: H5.0FT

Nominal Power: 60 kW
Attachment: 1500 mm Fork
P005B04125J 1 5000 kg N/A
Truck Weight: 7620 kg
Tread Width: 1150 mm
Back Tilt: 6.0 degrees

Particular of any test carried out as part

Visual and Functional Inspection Applicable Standards: ANSI ITSDF B56.6
of examination:

Date of last thorough examination: 14-Oct-2021 Date of next thorough examination: 27-Sep-2023

1) Is this the first examination after installation or assembly at a new site or location? Yes☐ No☒
2) Is the examination carried after any exceptional circumstance/alteration? Yes☐ No☒
3) Identification of any part found to have a defect which is or could become a danger to persons and
Yes☐ No☒
a description of the defect
4) Is the above defect of any danger immediately or at any date (specify)? Yes☐ No☒
5) Particulars of renewal/repair/rectification/replacement required to remedy the above affect Yes☐ No☒
6) Is the examination carried out within an interval of 6 months/12 months? 6 months☐ 12 months

The equipment tested and examined in accordance with the standards ASME / ANSI / BS EN / API / LOLER and at the time of inspection, herein were
found to be free from cracks or damages or flaws or any other defects which could become a danger to person. This Equipment is 'SAFE TO USE' at
the time of Inspection. This inspection certificate shall not be reproduced in part / in full without approval of Inspection body.

Name & position of the person who carried Mohamed Yasir Name of the Person Jayachandran Nair
out the Test and Thorough Examination Lifting Inspector Authenticating this Certificate Technical Manager

Signature: Signature: