IMO Dangerous Goods Declaration with CPC
IMO DANGEROUS GOODS DECLARATION
| |2. Transport Document Number: |
|1. Shipper: | |
| | |
| |3. Page 1 of pages |
| |4. Shipper’s Reference: |
| |5. Freight Forwarders Reference: |
| | |
|6. Consignee: |7. Carrier: |
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| | |
| |8. Additional Handling Information: |
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|9. Ship’s name / Voyage #: | |
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|10. Port of Loading: | |
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|11. Port of Discharge: |SHIPPER’S DECLARATION |
| |“I hereby declare that the contents of this consignment are fully and accurately |
| |described below by the Proper Shipping name(s) and are classified, packaged, |
| |marked, and labelled/placarded, and are in all respects in proper condition for |
| |transport according to applicable international and national government |
| |regulations. |
|12. On Carriage: | |
| | |
|13. Number | | | | |
|of Pieces |Kind of Packages |Description of Goods (i.e., UN #, Proper shipping name/correct |Net |Gross |
| |and Size |technical name. IMO Class/Div., Subsidiary Risk, PG Group…) |Weight (kg) |Weight (kg) |
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| |15. Seal Number: |16. Container/Vehicle Size: |17. Total Gross |
|14. Container/Vehicle Identification Number: | | |Weight (kg): |
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|18. Emergency Contact , Company Name & Phone Number (International & Domestic): |
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|19. CONTAINER/VEHICLE PACKING DECLARATION | |
|It is declared that the packing of the container/vehicle has been carried out in |20. Name of Company Preparing this Document: |
|accordance with the applicable provisions. | |
| | |
|Packing Company Name: |Name/Status of declarant: |
| | |
|Place and Date: | |
| |Place and Date: |
|Signature of Packer: | |
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| |Signature of declarant: |
| | |
| |2. Transport Document Number: |
|1. Shipper: | |
| | |
| |3. Page of pages |
| |4. Shipper’s Reference: |
| |5. Freight Forwarders Reference: |
|13. Number | | | | |
|of Pieces |Kind of Packages |Description of Goods (i.e., UN #, Proper shipping name/correct |Net |Gross |
| |and Size |technical name. IMO Class/Div., Subsidiary Risk, PG Group…) |Weight (kg) |Weight (kg) |
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