IMO Dangerous Goods Declaration - TBGFS
1 Shipper
IMO DANGEROUS GOODS DECLARATION
2 Transportation Document Number
6 Consignee
3 Page 1 of 1
PAGE
of
Pages 4 Shipper's Reference
5CFarrerigerh:t Forwarder's Reference
7 Carrier (to be declared by the Carrier)
SHIPPER'S DECLARATION I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name(s), and are classified, packaged, marked and
labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations.
10 Vessel/Flight and Date
9 Additional Handling Information
11 Port/Place Handling 14 Shipping Marks
Number and Kind of Packages, Description of Goods
GW (kg)
CUBE (m3)
15 CTU ID No.
16 Seal No.
17 CTU Size and Type
18 Tare Mass (kg)
19 Total Gross Mass (kg)
CCOoNnTtAaINinEeRr/V/VEeHhICicLElePPACaKcIkNiGngCECReTrItFiIfCicAaTte
I hereby declare that the goods described above have been packed/loaded into the container/vehicle identified above in accordance with the applicable provisions.
20 Name of Company
21 Receiving Organization Receipt Received the above number of packages/containers/trailers in apparent good order and condition,
unless stated hereon: RECEIVING ORGANIZATION REMARKS:
Hauler's Name
22 Name of Company Preparing Note
Name/Status of Declarant
Vehicle Registration No.
Name/Status of Declarant
Place and Date
Driver Name and Date
Place and Date
Signature of Declarant
Driver's Signature
Signature of Declarant
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