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CERTIFICATE OF EXAMINATION AND TEST OF ELEVATOR

Certificate No: Job No:

Client Name & Address

UNIT INFORMATION
Type of Inspection & Test Performed:
Elevator Id.:

Type of Use: Manufacturing Year:

Type of Driving Machine: Suspension Details:

Type of Door: Speed:

Make: Rated Load & Number of Person:

Floor Served: Attending Maintenance Company:

INSPECTION STATUS
Date of Previous Inspection: ASC Test Method No:
Date of Inspection & Test: ASC Test Equipment No:
Next Inspection & Test Due On: Standard Reference& Regulation:
Inspector Name: Authorized Name:

Inspector Signature: Authorized Signature:

This is to certify that the equipment described in this certificate was inspected and tested in accordance to the aforementioned standard and found free of major
defect and at the time of inspection the equipment is satisfactory for its intended use within the limits specified herein and that all the particulars are corre ct.

This certificate is granted subject to the condition that is understood and agreed that nothing herein contained shall be deemed to relieve any designer, manufacturer, seller, supplier,
Repairer or operator of any warranty, express or implied, and admiral safety consultants liability shall be limited to the acts or omissions of its employees, agents and
Subcontractors .under no circumstances whatsoever shall Admiral safety Consultants nor their Engineer be liable for any injury or damage to any person or occurring
by reason of negligent operation or any defect in material, machinery ,equipment or other items other than such defects ascertainable by normally accepted standards
and only those items actually inspected by Admiral Safety Consultant and which are covered only by this certificate. Any person not a party to the contract pursuant
to which this document is delivered may not assert claim against Admiral Safety Consultants for any liability arising out of errors or omissions which may be contained
in said document and in connection with any activities for which it may provide. This Certificate shall not be reproduced except in full without the approval of
Admiral Safety Consultants and Receiving Client

Note:
1. 1. The certificate is valid for 6 months (in accordance with EIAC-RQ-IB002) from the date of inspection.
2. 2. The certificate becomes invalid in case of any major repair, modification and/or alteration; in which case it must be re-inspected and re-tested.
3. 3. We advice that action be taken on the items mentioned in the subsequent pages and provide continuous preventive maintenance according to maker’s instruction.
4. As per the EIAC-REQ-IB-001 condition based validity certificates issued, you should close the finding before the target, otherwise becomes invalid.
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5. Once you rectified, you should inform to Admiral safety consultants. f2

ADMIRAL SAFETY CONSULTANTS, TRADE LICENCE NO. 741090,AL GARHOUD, P.O.BOX 125218, DUBAI -UAE, TEL: 04-2899389, FAX: 04-2840557
Doc.No.ASC-EL-C-52(Rev.05) (15/03/2020)
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Certificate No: Job No:

A FINDINGS: TARGET DATE

Doc.No.ASC-EL-C-52(Rev.05) (15/03/2020) Page 2 of 2

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