Undertaking for Registration/Renewal of Lift Registration

A. Lift No./ Registration No. F-4615/LP/2015/FBD

B. (Passengers/Goods):- Goods & Passengers Lift
C. Any incident occurs during last one year.
(With detail if any) NO
D. Consumer Electricity Bill (DHBVN) A/C No. 8744901000
E. Main source of supply with capacity of
Transformer D.G Set Electricity
F. Standby source of supply with capacity
Transformer/D.G Set PNG
G. Address Block No./ Tower No./ Lift No. ATM EXPORTSPVT. LTD
112, DLF Industrial Area,
Phase – 1, Faridabad, Haryana.

1. All the earth pits meant for earthing of the lifts system has been effectively maintained and
identified properly and the earth result measured in our presence the same was found
below one OHM which is satisfactory.
2. ARD system has been provided in each lift and the same is in working order.
3. Door sensors and alarm are working properly.
4. ELCB had been installed and working properly.
5. All the ropes provided in lifts are in the healthy condition.
6. The name and contact no. of the authorized person competent to handle the fault in the lift
system will be displayed inside the lift cabin.
7. Caution notices will be displayed with a barricading of the lift while carrying out
maintenance works on the lift.
8. Consistent compliance of the relevant provision of CEA Regulation 2010 will be
maintained in all the installation at our end to maintain and operate the installation in a
condition free from danger, as recommended by the manufacturer by the relevant code of
practice of the Bureau of India Standards instruction of lift inspector.
The above points were checked by the engineer of Maintenance Company who has
taken the AMC for the lifts, in my presence or my representative’s presence.

Signature of authorized signatory/Engineer Signature of owner/authorized

signatory of company who has taken of the Lifts.
the AMC/installed the New Lift. Name :- Harshit Kumar
Name:-………………………. Date:- 14/03/2024
dated:…………………………. Mobile. No. 9015790140
 To
Executive Engineer,
Electrical Inspectorate, Haryana,
Faridabad.

Details of Lift Installations offered for Inspection/Renewal of Registration Existing lift

(Regd. No. F-41615/LP/2015/FBD).
1. Name & Address of consumer/installation: ATM EXPORTS PVT. LTD.
112, DLF Industrial Area,

Phase – 1, Faridabad, Haryana

2. No. of Lifts (Passenger/Goods) 01 Goods & Passengers Lift

3. Name of owner/authorized person of
Organization with telephone/mobile No. Harshit Kumar
_9015790140
4. e-mail address of the firm hratmexports@gmail.com
5. State whether all the observations made
during last inspection have been attended? _ Nil

UNDERTAKING
We undertake that we shall maintain and operate the installations in a condition free from
danger and as recommended by the manufacturer and/or by the relevant Code of Practice of the
Bureau of Indian Standards and also certified that all the guidelines as per Haryana Lifts &
Escalator Act-2008 will be strictly followed.

Signature of owner/authorized
signatory with seal
Dated: - 14th March 2024
Enclosures:
1. Requisition for Renewal of Lift.
2. IIIrd Party Public Liability Insurance.
3. AMC.
4. Safety-cum-ARD Certificate.
5. Last Registration Copy (D- Form).
6. Inspection fees Treasury Challan deposited through www.hrtreasures.gov.in
 To
Executive Engineer, Electrical Inspectorate, Haryana,
Block C-2, Sushant Lok-I, Gurgaon.

Details of Lift Installations offered for Inspection/Registration of Newly installed

lift (Sr. No. _ ).
1. Name & Address of consumer/installation:

1. No. of Lifts (Passenger/Goods)

2. Name of owner/authorized person of
Organization with telephone/mobile No.
3. e-mail address of the firm
4. State whether all the observations made
during last inspection have been attended? _
UNDERTAKING
We undertake that we shall maintain and operate the installations in a condition free from
danger and as recommended by the manufacturer and/or by the relevant Code of Practice of the
Bureau of Indian Standards and also certified that all the guidelines as per Haryana Lifts &
Escalator Act-2008 will be strictly followed.

Signature of owner/authorized
signatory with seal
dated:……………………..

Enclosures:
1. Requisition for Registration/Renewal of Lift.
2. Completion & Test Report issued by Licensed Electrical Contractor (Form C).
3. IIIrd Party Public Liability Insurance.
4. AMC/Handover Acceptance.
5. Safety-cum-ARD Certificate.
6. A, B, C, E Form & Check List.
7. Inspection fees Treasury Challan deposited through www.hrtreasures.gov.in
 FORM F
[See rule 9]
NOTICE OF ACCIDENTS IN
To LIFTS
Inspector of Lifts
Cum
Executive Engineer,
Electrical Inspectorate, Haryana,
Block C-2, Sushant Lok-I,
Huda Primary School Building,
Gurgaon.

Under section 14 of the Haryana Lifts and Escalators Act, 200/, I/We hereby
inform you that an accident has occurred in the operation of lift at the place owned by
me/us __ _ on the
details of which are appended below.

I/we have discontinued the working of the lift, pending permission of the Inspector to
resume the working.
Yours faithfully,

Date: Owner of the Lift.