MULTIMODAL DANGEROUS GOODS FORM - SeaLand
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This form may be used as a dangerous goods declaration as it meets the requirements of SOLAS 74, chapter VII, regulation 5; MARPOL 73/78,Annex III, regulation 4 and section 9 of the General Introduction to the IMDG Code.
|Shipper |2. Transport document number |
| |3. Page of pages | 4. Shipper’s reference |
| | | 5. Freight forwarder’s reference |
| 6. Consignee | 7. Carrier (to be completed by the carrier) |
| |SHIPPER’S DECLARATION |
| |I hereby declare that the contents of this consignment are fully and accurately |
| |described below 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 government regulations. |
| 8. This shipment is within the limitations |9. Additional handling information |
|prescribed for: (Delete non-applicable) |Emergency contact person : |
| | |Emergency contact telephone: |
|10. Vessel/flight no. and date |11. Port/place of loading |EMS : |
| |SHANGHAI, CHINA | |
|12. Port/place of discharge |13. Destination | |
|14. Shipment information Number and kind of packages; description of goods ( *see bottom) |
| |
|Un no. : |
|Proper shipping name : |
|Technical name : |
|Imo class : |
|Packing group : |
|Flash point : |
|Marine pollutant : |
|Boiling point : |
|Package quantity and type : |
|Packing Code : |
|Gross Weight : |
|Net Weight : |
|Limited quantity : |
|Lighter's brand and factory : |
|Inner package : |
|15.Container number. |16. Seal number(s) |17.Container Size & type |18. Tare mass (kg) | |
|CONTAINER/VEHICLE PACKING CERTIFICATE |21. RECEIVING ORGANIZATION RECEIPT |
|I hereby declare that the goods described above have |Received the above number of packages/containers/trailers in apparent good |
|been packed/loaded into the container/vehicle identified |order and condition, unless stated hereon: RECEIVING ORGANISATION |
|above in accordance with the applicable provisions. ** |REMARKS: |
|MUST BE COMPLETED AND SIGNED FOR ALL | |
|CONTAINER/VEHICLE LOADS BY PERSON RESPONSIBLE | |
|FOR PACKING/LOADING | |
|20. Name of company | |22. Name of company |
| | | |
| | | |
|Name/status of declarant |Signature and date |Name/status of declarant |
|Place and date | |Place and date |
|Signature of declarant |DRIVER’S SIGNATURE |Signature of declarant |
* DANGEROUS GOODS:
You must specify: UN No., proper shipping name/correct technical name, IMO hazard class (subrisk), Packaging group (where assigned), Marine
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Classification: Internal
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