FORM X [See Rules 69 and 73] Certificate of Annual Thorough Examination of Loose Gears Exemptt from Annealing (a) Name of the Construction site where loose gears are fitted/ installed/ A manupatra® wong a deat: wo Distinguishin, Description of Number of certificate of Remarks number or mar! Gear initial and periodical test and examination a) ne) - 3).Name and address of public service, Name and position of Commetent Persan association, company or firm or testing _of public service, assoc! manupatra® establishment making the test and examination or firm or testing esaunouinicin (5). _ _ _ (6) 1 certify that on the. y .19...the above gear, described in colurin (2) was thoroughly examined; and that no defects affecting its safe working condition were found other than those indicated in column (4) Signature of the Competent Person Seal Date Registration/Authority number of the Competent Person.