FORM 11

PIS\2300\2014-15\THN
(See rule 62 & 64)
(Prescribed for report of examination of lifting machine, rope & lifting tackles)
1] Name of the occupier.
: M/s R M MANLIFT RENTAL
2] Name address of the factory.
: Building No.1,Gala No.28,
Indian Corporation, Village Dapada,
Tal- Bhiwandi, Thane (W)-421302
3] A. Type identification or reconstruction of
Hoist ,lift lifting machine, chains, ropes
Of the lifting tackle.

B. Date of construction or reconstruction & the

Date when the hoist, lift, lifting, machine,
Chains, ropes & lifting tackles were first
Taken into use in the factory.
4] Date of last examinations made under section
28(1) (a) (ii) & 29 (1) (a) (iii) & by whom it
Was carried out.

Old & Used Secondhand Streight JLG Boom

Sr.No. 0300057596, Platform Capacity: 227 Kgs
Make: JLG lndustries USA
Model: 600S, Colour: Orange & White
Type of Body: Arti Steet Maximum,
Platform Height : 60 Feet,
Year of Manufacturing:2011
December 2011

The previous test report is available for reference.

This is signed & issued by precision inspection

services on 20/12/2013
5] A. Maintenance (list of Parts ,if any, which were
: N.A.
Inaccessible) are the following parts of the
Hoist of lift properly maintained & in good
Working order ?
If not, state what defects have been found:(a) Enclosure of hoist way or lift way.
(b) Landing gates & cage gate (S)
(c) Interlocks on the landing gates & cage guides.
(d) Other gate fastenings
(e) Cage & platform & fittings, cage guides, buffers,
interior of the hoist way of lift way.
(f) Overrunning devices
(g) Suspension ropes or chains & their attachments.
(h) Safety gear, i.e. arrangements for preventing fall of
platform or cage brakes.
(i) Brakes
(j) Work of spur gearing
(k) Other electrical equipment
(l) Other part
B. Date & number of the certificate relating to
: Thoroughly Examined & Load tested by the
Any test & Examination made under sub rule
undersigned and found in good and sound
(1) Of rule 64 together with the name of person who
working condition on 19/12/2014
issued the certificate.
C. (i) Date of annealing or other heat treatment
: NA
Of the chain & lifting tackle carried out
Under sub rule (5) of rule 65 & by whom
It was carried out.
ii) Particulars of any defect found at any such
: NIL
examination or after annealing and affecting the
safe working load and steps taken to remedy
Such defect.
6. Repairs, renewals or alterations (if any) required
: N.A.
& the period within which they should be
Executed & maximum safe working load subject
To repairs, renewals or alterations (if any)
I/We certify that on 19/12/2014 I/we thoroughly examined the hoist, lift, lifting Machine, rope &lifting tackle and details of

Note: - Next Examination & Test will be due on 18/12/2015

PRECISION INSPECTION SERVICES Ph: - 9224496160