Shippers Declaration for Dangerous Goods



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SHIPPER’S DECLARATION FOR DANGEROUS GOODS

| | |

|Shipper |Air Waybill No. ХХХ-ХХХХ ХХХХ |

| |Page Х of Х Pages |

| | |

| |Shipper’s Reference Number |

| |(optional) |

|Consignee | |

| | |

| | |

|Two completed and signed copies of this declaration must be handed to the | |

|operator. | |

| |WARNING |

|TRANSPORT DETAILS | |

|This shipment is within the |Airport of Departure: |Failure to comply in all aspects with the applicable |

|limitations prescribed for: | |Dangerous Goods Regulations may be in breach of the applicable law,|

|(Delete non-applicable) |MINSK |subject to legal penalties. |

|PASSENGER AND |CARGO AIRCRAFT | | |

|CARGO AIRCRAFT |ONLY | | |

|Airport of Destination ХХХХХХХ | |Shipment Type (Delete non-applicable) |

| | | | | |

| | |NON-RADIOACTIVE |RADIOACTIVE | |

| |

|NATURE AND QUANTITY OF DANGEROUS GOODS |

|Dangerous Goods Identification | | | |

| | | | | | | |

|UN or | |Class or |Pack-ing |Quantity and |Pack |Author-izati|

|ID No. |Proper Shipping Name |Division |Group |Type of |Inst. |on |

| | |(Subsidiary | |Packing | | |

| | |Risk) | | | | |

| | | | | | | |

|Additional Handling Information |

| |

| | |

|I hereby declare that the contents of this consignment are fully and accurately |Name/Title of Signatory |

|described above by the proper shipping name, and are classified, packaged, marked and | |

|labelled/placarded, and are in all respects in proper condition for transport according |ХХХХХХХХХ |

|to applicable international and national governmental regulations. I declare that all of|Place and Date: ХХХХХХХХ |

|the applicable air transport requirements have been met. | |

| |Signature |

| |(see warning above) |

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