CERTIFICATE

Of Test And Thorough Examination Of Forklift Truck

Date Of Inspection : 26-12-2022
Client's Name : Maraba Al Iraq Al Khadra'a : LTG-IQ/A251417
Certificate No.
Address : Oil Operation Street, Near Police Training
Job No. : 4081
Center Burjesia Basra : Iraq Basra : Iraq
61006 Reference Standard : BS ISO 22915-2 &8: 2008,+ BS ISO
2330:2002,ISO5057
Type Of Inspection : In-Service Inspection Inspection Method : DOC/FL- 018,ISSUE 02/REV
05,17.06.2021

Site Name : Liftek Facility Sub Location : Basra

ASSET DESCRIPTION: Diesel Powered Hydraulically Operated truck forklift

Serial Number : 30E31730 Height of Lift : 6000 (mm)

Make : Unicarriers Date of Previous Proof Load Test : 13-3-2022
Model : 1F6F70U Cert. No.of Previous Proof Load
: LTG-IQ/A220996
Test.
Chassis No. : 80-31730
7000 kgs @ 600mm load
Regn. No. : 3576-Erbil Safe Working Load :
center
Mfg. Year : 2018
7000 kgs @ 600mm load
Fork Length : 1800 (mm) Test Load :
center
EXAMINATION DETAILS
Is the equipment installed correctly? Yes Is the equipment safe to use ? Yes
Particulars of other tests carried out: None State if any part was inaccessible: Nil
Particulars of defects where follow up is needed : Nil
Due date to rectify defects identified above Not Applicable
Details of Deviations/Omissions from original scope of work (if any): Details of Sub contracted work (if any):
NIL NIL
VALIDITY OF THIS CERTIFICATE CEASES IN THE EVENT THE
Due Date of Next Inspection
EQUIPMENT UNDERGOES A MAJOR REPAIR OR ALTERATION, IN
25-12-2023
WHICH CASE IT MUST BE RETESTED.
Equipment Used : Result : PASS

Name and Signature of Inspector :AHMED JIHAD Counter Signature

This is to certify that the above signed competent inspector has visually and functionally examined the equipment as per international standards.The
certificate has been prepared in accordance with requirements of EIAC requirements and shall not be reproduced except in full without the approval of the
inspection body and the client. No detail contained herein shall be deemed to relieve any designer, manufacturer, seller, repairer or operator of any warranty,
express or implied. Liftek Iraq's liability shall be limited to the acts or omissions of its employees, agents and subcontractors. Under no circumstance
whatsoever shall Liftek Iraq be liable for any injury or damage to any person or equipment occurring by negligent, incorrect operation or maintenance, defects
in material, wear and tear damages of machinery or other items related to the items covered by this certificate.

F/7.5/R64 Issue : 02 24-02-2014

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ANNEXURE
Of Test And Thorough Examination Of Forklift Truck
Certificate Number : LTG-IQ/A251417 Job Number : 4081 Date Of Inspection : 26-12-2022
Examination Details
No. EXAMINED ITEMS STATUS COMMENTS / VALUES
CHECK POINTS
1 DAILY/MONTHLY INSPECTION RECORD Satisfactory
2 MAINTENANCE RECORD Satisfactory
3 MANU.OPERATIONS & MAINT. MANUAL Satisfactory
4 PREVIOUS INSPECTION CERTIFICATE Satisfactory
5 DATA PLATE - Check for availability & legibility Satisfactory
6 LOAD CHART - for availability & legibility Satisfactory
CHASSIS FRAME - any damage, cut, dent,
7 Satisfactory
crack etc
8 WARNING LABELS - for availability & legibility Satisfactory
ENGINE HOUSING -for any damage,
9 Satisfactory
cleanliness and availability of guards
ENGINE OIL LEVEL - ensure the oil is within
10 Satisfactory
the limit
HYDRAULIC TANK- for damage, leakage,
11 Satisfactory
corrosion etc.
HAND CONTROLS - for proper marking,
12 Satisfactory
proper functions, damage, dead-man facility etc
FOOT CONTROLS- for proper functions,
13 Satisfactory
check brake condition in forward and in reverse.
SEAT - for any damage, torn, proper fitting,
14 Satisfactory
availability of seat belt etc.
HEAD LIGHTS - for availability and
15 Satisfactory
functionality
BEACON LIGHTS - for availability and
16 Satisfactory
functionality
INDICATOR LIGHTS - for availability and
17 Satisfactory
functionality
REVERSE ALARM - for availability and
18 Satisfactory
functionality
19 HORN - for availability and functionality Satisfactory
20 MIRROR- for availability and its condition Satisfactory
21 ALL GAUGES - For any damage, functionality Satisfactory
22 WIND SHIELD - check its condition Not Applicable
TILTING CYLINDERS - for damage, leakage,
23 Satisfactory
smooth operation, proper fixing etc.
LIFTING CYLINDER - for damage, leakage,
24 Satisfactory
smooth operation, proper fixing etc.
COMMENTS
REGULAR MAINTENANCE NEEDS TO BE PERFORMED ON THIS EQUIPMENT.
 Equipment maintenance record
Name of equipment & model
: Diesel Powered Hydraulically Operated truck forklift
Plate # 3576-Erbil Manufacture name Unicarriers
CHASSIS NO 80-31730 2018
Year of manufacture
Model 1F6F70U Company responsible forequipment Maraba Al-Iraq Al-Khadra'a

Maintenance Next maintenance

Date Maintenance description Date of service Performer signature Remarks
performed by planned to date
Side mirror
After inspection some damage WS
19/05/2023 19/05/2023 19/06/2023 Sabri Nahar Ok
and crack in mirror so
replacement

Replacement 1 tire
19/06/2023 WS 19/06/2023 19-07-2023 Sabri Nahar Ok
Check hydraulic level