T.C. No.

J-LT-387/23
FORM NO. 11
(See rules 62 and 64)
Report of examination of hoist, lift, lifting machine, chains, ropes and lifting tackles
1. Name of the Occupier : M/s. Sangat Crane Service
2. Name and Address of the Factory : Kharghar, Maharashtra

3. (a) Type Identification number and description of : D’Shackles Qty: 3 Nos.

hoist, lift, lifting machine, chains, ropes and lifting SWL – 17 Ton / Each
tackles Id Nos. 9,12,13

(b) Date of construction or reconstruction and thedate when : NA

the hoist, lift, lifting machine, chains,ropes and lifting
tackles were first taken into use in the factory.

4. Date of last examinations made under section 28(1) (a) (ii) : As per Factory Record
and 29(1)(a)(iii) and by whom it was carried out.

5. (A) Maintenance:(List of parts, if any,which were inaccessible) : Maintained OK

Are the following parts of the hoist or lift properly maintained
and in good working order ?
If not, state what defects have been found:- : N.A.
(a) Enclosure of hoistway or liftway. : N.A.
(b) Landing gates and cage gate(s). : N.A.
(c) Interlocks on the landing gates and cage gate(s). : N.A.
(d) Other gates fastenings. : N.A.
(e) Cage and platform and fittings, cage guides, : N.A.
buffers, interior of the hoistway or liftway.
(f) Overrunning devises. : N.A.
(g) Suspension ropes or chains and their attachments. : N.A.
(h) Safety gear, i.e. arrangements for preventing fall : N.A.
of platform or cage brakes.
(i) Brakes. : N.A.
(j) Worm or spur gearing : N.A.
(k) Other electrical equipment. : N.A.
(l) Other parts : N.A.
(B) Date and number of the certificate, relating to any test and : Thoroughly examined & load tested by us
examination made under sub- rule( 1) of rule 64 together on 29-07-2023 No Defects affecting SWL
with the name of the person who issued the certificate. Found in good & sound working condition
Certified for use at rated capacity of 17 Ton
(C) (i) Date of annealing or their heat treatment of the chain and : Not Applicable
lifting tackle carried out under sub-rule (5) of rule 64
and by whom it was carried out.
(ii) Particulars of any defect found at any such examination : Nil
or after annealing and affecting the safe working load
and of the steps taken to remedy such defect.
6. Repairs, renewals or alterations (if any) required and the period : Nil
within which they should be executed and maximum safe working
load subject to repairs, renewals or alternations (if any)
I/We certify that on 29-07-2023, l/We thoroughly examined the hoist, lift, lifting machine, ropes and lifting tackles and details of
examinations / tests carried out is enclosed herewith that the above is a correct report of the result.

Signature : Countersignature
If employed by a company or association,
give name and address
Qualification:

Address : C-6/3/2:2, Sector-06, CBD, Navi Mumbai-400614

Date : Valid up to 28-07-2024
 T.C. No. J-LT-388/23
FORM NO. 11
(See rules 62 and 64)
Report of examination of hoist, lift, lifting machine, chains, ropes and lifting tackles
1. Name of the Occupier : M/s. Sangat Crane Service
2. Name and Address of the Factory : Kharghar, Maharashtra

3. (a) Type Identification number and description of : Bow Shackles Qty: 2 Nos.
hoist, lift, lifting machine, chains, ropes and lifting SWL – 17 Ton / Each
tackles Id Nos. 10,11

(b) Date of construction or reconstruction and thedate when : NA

the hoist, lift, lifting machine, chains,ropes and lifting
tackles were first taken into use in the factory.

4. Date of last examinations made under section 28(1) (a) (ii) : As per Factory Record
and 29(1)(a)(iii) and by whom it was carried out.

5. (A) Maintenance:(List of parts, if any,which were inaccessible) : Maintained OK

Are the following parts of the hoist or lift properly maintained
and in good working order ?
If not, state what defects have been found:- : N.A.
(a) Enclosure of hoistway or liftway. : N.A.
(b) Landing gates and cage gate(s). : N.A.
(c) Interlocks on the landing gates and cage gate(s). : N.A.
(d) Other gates fastenings. : N.A.
(e) Cage and platform and fittings, cage guides, : N.A.
buffers, interior of the hoistway or liftway.
(f) Overrunning devises. : N.A.
(g) Suspension ropes or chains and their attachments. : N.A.
(h) Safety gear, i.e. arrangements for preventing fall : N.A.
of platform or cage brakes.
(i) Brakes. : N.A.
(j) Worm or spur gearing : N.A.
(k) Other electrical equipment. : N.A.
(l) Other parts : N.A.
(B) Date and number of the certificate, relating to any test and : Thoroughly examined & load tested by us
examination made under sub- rule( 1) of rule 64 together on 29-07-2023 No Defects affecting SWL
with the name of the person who issued the certificate. Found in good & sound working condition
Certified for use at rated capacity of 17 Ton
(C) (i) Date of annealing or their heat treatment of the chain and : Not Applicable
lifting tackle carried out under sub-rule (5) of rule 64
and by whom it was carried out.
(ii) Particulars of any defect found at any such examination : Nil
or after annealing and affecting the safe working load
and of the steps taken to remedy such defect.
6. Repairs, renewals or alterations (if any) required and the period : Nil
within which they should be executed and maximum safe working
load subject to repairs, renewals or alternations (if any)
I/We certify that on 29-07-2023, l/We thoroughly examined the hoist, lift, lifting machine, ropes and lifting tackles and details of
examinations / tests carried out is enclosed herewith that the above is a correct report of the result.

Signature : Countersignature
If employed by a company or association,
give name and address
Qualification:

Address : C-6/3/2:2, Sector-06, CBD, Navi Mumbai-400614

Date : Valid up to 28-07-2024