Dangerous Goods Declaration



Dangerous Goods DeclarationShipper/Consignor/Sender of RecordTransport document number -Page ofpages1/1Shipper’s referenceBooking No.ONEYFreight Forwarder's referenceConsigneeCarrier (to be completed by carrier)ONEVessel Name and voyage24 HOUR NUMBER-EMERGENCY CONTACT (TEL with international access code is needed)Additional handling information:Place of receiptPort/place of loadingPort/place of dischargeDestinationPlacards/Signs:Shipping marksNo. and kinddescription of goods Gross Weight/ Net Weight(kg)of packages(UN, PSN, CLASS, PG) Net Explosive Qty.(class 1 only). Container identification no./ vehicle registration no.. Seal number(s). Container/Vehicle size & type. Tare mass (kg). Gross / Net Weight excluding tare (kg)CONTAINER/VEHICLE PACKING CERTIFICATEIt is declared that the packing of the goods into the container/vehicle identified above has been carried out in according to the applicable provisions.MUST BE COMPLETED AND SIGNED FOR ALLCONTAINER/VEHICLE LOADS (other than tanks) BY THE PERSON RESPONSIBLE FOR PACKING/LOADING.SHIPPER’S DECLARATIONI hereby declare that the contents of this consignment arefully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded and are in all respects in proper condition for transport according to the applicable international and national governmentalregulations.MUST BE COMPLETED AND SIGNED FOR ALL DANGEROUS GOODS CONSIGNMENTS BY THE PERSON RESPONSIBLE FOR OFFERING THEDANGEROUS GOODS FOR TRANSPORT PER IMDG CODE 5.4.1.1.11.Name of company packing containerName of company of shipperName /status of declarantName/status of declarantPlace container/vehicle packedDate packed:Place and dateSignature of declarantSignature of declarant ................
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