Imo Dangerous Goods Form
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1IMO DANGEROUS GOODS DECLARATION
This form meets the requirements of SOLAS 74 chapter VII, regulation 5; MARPOL 73/78 Annex III, regulation 4 and the
IMDG Code, General Introduction, section 9.
Shipper:
Reference Nbrs:
Carrier:
Consignee:
Name/Status, company/organization of signatory:
Container packing certificate/vehicle declaration
DECLARATION
Place & Date:
It is hereby declared that the packing of the container
Signature on behalf of shipper:
has been carried out in accordance with the General
introduction, IMDG Code, paragraph 5.4.2.
Ship's Name and Voy. #:
Port of Loading:
Special Instructions:
Port of Discharge:
Goods Delivered As:
Type of Unit & Unit Nbr.:
Qty., Type & Kind of
Pkgs. Size
No.
Description (inc. basic description, add'l descriptive info, ER, phone, etc.)
Mass/Volume/Cube
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Additional Information:
DECLARATION
Name/status, company/organization or signatory:
It is hereby declared 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
Signature on behalf of shipper:
condition for transport according to applicable
international and governmental regulations.
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