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:       |

|      | |

| | |

| |8. Additional Handling Information: |

| |      |

|9. Ship’s name / Voyage #: | |

|      | |

|10. Port of Loading: | |

|      | |

|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) |

| | | | | |

|      |      |      |      |      |

| | | | | |

|      |      |      |      |      |

| | |      | | |

|      |      | |      |      |

| |15. Seal Number: |16. Container/Vehicle Size: |17. Total Gross |

|14. Container/Vehicle Identification Number: |      |      |Weight (kg):       |

|      | | | |

| |

|18. Emergency Contact , Company Name & Phone Number (International & Domestic): |

|      |

|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: |      |

|      | |

| |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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