declaration 空白表格Dangerous Goods Declaration
1. Shipper/Consignor/Sender of Record
2. Transport document number -
3. Page of pages
4.
5. Shipper’s reference
Booking No.
5. Freight Forwarder's reference
6 Consignee
PH
7 Carrier (to be comple...
Dangerous Goods Declaration
1. Shipper/Consignor/Sender of Record
2. Transport document number -
3. Page of pages
4.
5. Shipper’s reference
Booking No.
5. Freight Forwarder's reference
6 Consignee
PH
7 Carrier (to be completed by carrier)
Vessel Name and voyage
8. Emergency contact telephone (with international access code)
9.
Additional handling information:
10. Place of receipt
S
11. Port/place of loading
12. Port/place of discharge
13. Destination
Placards/Signs:
14. Shipping marks
No. and kind description of goods Gross mass (kg)
of packages (PSN, Class, UN, PG)
Net Explosive Qty. (class 1 only)
15. Container identification no./ vehicle registration no.
T
16. Seal number(s)
17. Container/vehicle size & type
18. Tare mass (kg)
19. Total gross including tare (kg)
CONTAINER/VEHICLE PACKING CERTIFICATE
It is declared that the packing of the goods into the container/vehicle identified above has been carried out in accordance with the applicable provisions.
MUST BE COMPLETED AND SIGNED FOR ALL CONTAINER/VEHICLE LOADS (other than tanks) BY THE PERSON RESPONSIBLE FOR PACKING/LOADING.
SHIPPER’S DECLARATION
I hereby declare that the contents of this consignment are
fully 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 governmental regulations.
MUST BE COMPLETED AND SIGNED FOR ALL DANGEROUS GOODS CONSIGNMENTS BY THE PERSON RESPONSIBLE FOR OFFERING THE DANGEROUS GOODS FOR TRANSPORT PER IMDG CODE 5.4.1.1.11.
20. Name of company packing container
J.
22. Name of company of shipper
Name/status of declarant
Name/status of declarant
Place container/vehicle packed
Date packed:
Place and date
Signature of declarant
Signature of declarant
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