LAXMI ENGINEER #101 Pratap Nilayam, Pragathi Nagar, Hyderabad-500090, Telangana State, INDIA Email Id; laxmiengineers62 @gmail.com, laxmiengineers62@yahoo.com Mobile Number: 8019983405, 9948130043, 9676231139. Form No. 38 Prescribed under Rule & 55-4, Factory Act (Report of examination of Hoist or Lift or Lifting Machinery / Tackle) Ref.No.1207202FL/O1 ‘Name of the occupier, Address of the Factory ‘Mis. SAT VINAYAKA ENTERPRISES Site: Adani Elikatta Village, Shadnagar, Telangana, T 4) Type of Equipment, model, Make description of Lifting Machinery / Tackle and Distinguished number, mark, identification ‘number or description + FORK LIFT, MAKE: KION INDIA PVE LTD, Model: DVXS06AIBIDHVT2100, Cap: STons, Vehiele Not TSO9F/TR7603 b) "Name & Adairess of Manufacturer, Date oF Construction or reconstruction, 2023 ‘State Design and construction condition, ‘The Fork Lifts of Standard design © Construction, The Sane in norma \wotking condition as ascertained by us and fit for working with specified load. 3°] Maintenance: Are all the parts of the Lift properly ‘maintained and in good working Order? If not, state what defects have been found. FORK LENGTH: [100MM _ SRNo:KN6764M00609 * SIV-1-16-F2304675000693, Location: Site ‘@) Electrical equipment and parts NA 'b) Mechanical drive serew rods, drive chain, Wire rope and other moving and stationary part & structure. ‘What parts (iFany) were inaeeessible 6 a) Repairs renewals or alterations required. 'b) Particulars of the parts rejected after the examination, 7 | Maximum Safe working load subject to repairs, renewals or alterations. if specified in Row No. 6. 7 SW 2ST 3°] Details of load test carried out. Particulars of any. defects affecting the safe working load, found at the time of thorough examination + The above said Fork Lift is load tested with 41. capable to handle loads up to rated eapacity SWL: 2.5T TWe certify that on 1207 result. Tis certificate is Val Upto: 1012024, Name ofthe Competent Person: G.Naveen Bhargay Regn No: L. Dis A4/1310/2023, Valid: 08-04-2024 23. We thoroughly examined this Hoist Lift Lifting Machine’ Tackle andthe above isa corvect port of he et aoe Signature Vv AVEEN BHARGA\ &.Nmpetent Person Govt. of Telangana