Certificate No.

: SSS/07-22 /CPB - 5T
PRESCRIBED FOR REPORT OF EXAMINATION FOR CRANES AND OTHER LIFTING MACHINES
i. Name of the Occupier of factory
ii. Address of the factory/Owner of the Equipment
iii. Distinguishing number of mark (if any) and
description sufficient to identify the lifting machine,
chain, rope or the lifting tackle
iv. Date when lifting machine, chain, rope or tackle was
first taken into use in the factory
v. Date and number of the certificate relating to any
test and examination made under rule 64 (5) and 64
(6) together with the name and address of the person
who issued the certificate
vi. Date of each periodical through examination made
under clause (a) (ii) of sub-section (1 or section 29 or
the Act and Rule 64 (7) and by whom it was carried
out.
vii. Particulars of any defects affecting the safe working
load found at such through examination or after
analyzing and of the step taken to remedy such
defects
FORM NO. 32
(See Rule 63)
: M/s. GOODWILL INFRA & CRANES
: M/s. GOODWILL INFRA & CRANES
# 3, Ground Floor, Manjunatha Nilaya,
Horamavu post, Bangalore- 560043
Inspected @ Site : Shapoorji pallonji & Co. Pvt Ltd
Goraguntepalya, Yeshwanthpur, Bangalore – 560022
C / P – N.V. SRINIVAS RAO - 8088021889
: 1).CHAIN PULLEY BLOCK
LOCAL ID No. : CPB – 1, Cap : 5 T,
Make, Sr. no, Chain Dia, YOM - are as per MFR Manual
chain Length - As per site Requirment
Type: Chain Pulley Block Arrangement.- 1 / 2 Fall Type
HOOK BLOCK - Capacity -5Ton
Total qty inspected : 01 no , Cleared : 01 no
:
Used Equipment/Machinery
:
First Inspection
: On 28/07/2022 Thoroughly Inspected by
SUSUM S. SRINIVAS, B.E. (Mech), MIE, CE.FIV
As Competent Authority.
: Detailed visual inspection has been carried out, Performance Check
and load Test Was carried out it was Found Satisfactory.
DEFECTS : NIL, FIT FOR USE,
Recommended SWL : 4 Tons

I certify that on 28-07-2022 thoroughly examined the above mentioned lifting machine, chain / rope / lifting tackle and that
is a correct report of the result. Next Certification Due on 27-01-2023, or in case any major maintenance problems.

Recommendations / Remarks / Notes / Observations:

1. Visual Check : Condition of the Chain Block, its Construction, dimensional check, deformation free of Load
Chain, end fittings, Guide Pulleys, all movements with and without Load, Load Hoisting and Breaking, Load
Lowering & raising and Load holding performance – Satisfactory.
2. Advised to De-rate the safe working load by 10%, since the equipment is old.
3. Recommended to lift the load only after proper balancing using tested slings.
4. Disclaimer: Any operational/usage failure, because of improper usage over loading un-even loading, improper
commands, improper preventive maintenance, Not Noticing the leakages if any in the Gear Box, any alterations /
changes in the equipment original requirements, etc., the responsibility entirely lies on the occupier.
5. Validity: 6 months from the date of issue.

Name & Address of the Competent person:

SUSUM S. SRINIVAS, B.E. (Mech.) MIE, CE, FIV
Authorisation No. PVPSMC/FYA/CR-31/2021–22, Date: 23-11-2021
Chartered Engineer, Membership No.: M-160031-6
Approved Valuer: Plant & Machinery-Membership No.: F-27586
# 32/2, 3rd Cross, Cashier Layout, Tavarekere, B.T.M. 1 Stage
Bangalore – 560 029, (M) : 9036396077
E Mail: susumsrinivas60@gmail.com Seal and Signature