FORM B

UINISiTRY OF iIANPOWER, SINGAPORE LE Registration lto. : Li1952340P

WORKPLACE SAFEry AND HEALTH ACT 2006 UEN of 0rner. : 52812183M
WORKPLACE SAFETYAND HEALTH (REGISTRATION AND OTHER Workplace No. :

SERV]CES FEES AND FORMS) REGULATIONS

CERTIFTCATE OF TEST'THOROUGH VISUAL EXAiIIINATION
oF LTFTTNG EAUIPUENT (LEF

Owner of Lifting Equipment Factory Occupier and Location of Lifting Equipment

UOON FONG LENG EXGAVATOR RENTAL AND
TRADING At various locations
28 NEW UPPER CHANGI ROAD'O6.736
SINGAPORE 460028

Particulars of Lifting Equipment

Type and Description 699 Other Mobile Granes. n.e.c. Classification Code : 699
of Lifting Equipment Hydraulic Excavator With Lifting Hook
Brand Narne KUBOTA U.50.5 Distinctive No. * 7A712
Country of Origin JAPAN Date of Manufacture : 2O13
Source of Power Diesel Engine First Registration Date : 2310912021
Max. Safe Working Load : 900 kg Max. Boom LengthlSpan : 4.20 m
Owners' Length of Fly
ReferenceA/ehicle JiblExtension
Registration No"

Particulars of Last Load Test

Date of Load Test : 231O912A21 Max Test Load 1125 kg
{1 (4) (5)
Radius (m): 2-A 5.3
Test Load (kg) 1125 4:!0
Safe Working Load (kg) 900 350

Comments/Observations
Located at Changi Coast Road LP278-
Excavator fitted with load radius indicator & lifting hook with safety latch on the H-Link.
Advise to have proper maintenance and ensure safe use of LE-

I certifu that on 23109nA21 the lifting equipment described in this certificate was examined thoroughly by me, as far as its
construction pennits, and this is a true report of my examinations.
I further certify that the lifting equipment complies in all respects with the requirements pertaining to lifting equipment as
stipulated in the Workplace Safety and Health (General Provisions) Regulations, and all other regulations made thereunder
and is safe for use.

Expiry Date of
Certificate
Date of Print of
Certifrcate
Authorised Examine/s Name sisnay6fR$F&S-**
-\{\
2A09nO22 231tgt2421 NG KIM LEANG
€
a- rn
7

. Lifting Equipment means Lifting Gear, Lifting Appliance, Lifting Machine, Lift and Hoist as defined under the sxetya&16iln
Provisions) Regulations.
** Number/Serial Number assigned to the equipment by the manufacturer

W
Distinctive Number refers to the ldentification
\) A P