DERATION REQUEST FORM

• Deration Title

• Completed on

  Date

• Prepared by

• Department

• Warehouse

• End User

• Date

  Date

• Plate Sent To

Machine Details

• Truck Type

• Serial Number

• Mast Height

• Mast Type

• Rated Capacity

• Rated Load Centre

• Sideshift

For Counter Balance Machines

• Truck weight

• Tyre Type

• Front Tyre

• Tyre Size Front

• Tyre Size Rear

• Production Year

For Battery Powered Machines

• Battery V

• Battery AHC

• Min Battery Weight

• Max Battery Weight

Actual Capacity (off truck data plate)

• Actual Capacity (off truck data plate)

Lift Height

• Lift Height (mm)

• Load Centre (mm)

• Capacity (kg)

• Load Centre 2 (mm)

• Capacity 2 (kg)

• Load Centre 3 (mm)

• Capacity 3 (kg)

Fork Specification (if forks are used e.g. hook on sideshift)

• Class

• Rated Capacity

• At (Load Centre)

• Length

• Width

• Thickness

Attachment

• Attachment Details

Attachment

• Manufacturer

• Type

• Model

• Serial No.

• Rated Capacity

• At (Load Centre)

• Centre of Gravity

• Lost Load centre

• Mass

• For Reach Attachments - For any attachments that reach out (Kooi forks, pantographs, push/pull attachments) please ensure the below is completed.

• Extended Capacity

• At (Load Centre)

• Extended Centre of Gravity

Load Details

• Load

• Length

• Width

• Height

• Centre of Gravity

• Weight

• Notes - Detail any relevant information about truck or attachment/s which may affect the capacity of the truck

Residual Capacity

• The Residual capacities stated herein, and the associated rating plate (where provided), have been produced in good faith based entirely on the information provided to Technical Services in this document. As the manufacturer, or their representative, Technical Services cannot be responsible for any inaccuracy or resultant damage due to incorrect information.