Home Lift - Elevating platform
Test instructions
Subject to change without notice!
EXCELLENCE IN COMPONENTS
Date
07/10/2011
Sheet
13
Version
11117320015V02
Approved
ISC
Original instructions
Annex 1 Test report
The examination certificate shall contain the following information.
TEST REPORT
Name of the examiner: ...................................................................................................................................
examination certificate: ..................................................................................................................................
examination N°: .............................................................................................................................................
1 Category, type and make or trade name: ...................................................................................................
2 Manufacturer's name and address: ............................................................................................................
3 Name and address of certificate holder: ....................................................................................................
4 Date of submission for examination: ..........................................................................................................
5 Certificate issued on the basis of the following requirement: .....................................................................
6 Test laboratory (if any): ..............................................................................................................................
7 Date and number of report: ........................................................................................................................
8 Date of examination: ...................................................................................................................................
9 The following documents, bearing the examination number shown above, are annexed to this certificate:
...........................................................................................................................................................................
10 Any additional information: .........................................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
Place: ................................................................. ...................................................................................
(Date)
...................................................................................
(Signature)
