Imo Dangerous Goods Declaration printable pdf download

Imo Dangerous Goods Declaration

IMO DANGEROUS GOODS DECLARATION

1. Shipper :

2. Transport Document Number :

3. Page 1 of 1 pages

4. Shipper’s Reference :

5. Freight Forwarders Reference :

6. Consignee :

7. Carrier :

8. Additional Handling Information :

9. Ship’s name / Voyage  :

10. Port of Loading :

11. Port of Discharge:

SHIPPER’s DECLARATION

« I hereby declare that the contents of this consignement are fully and

accurately described below by the Proper Shipping name(s) and are classified,

12. On Carriage:

packaged, marked and labelled/placarded, and are in all respects in proper

condition for transport according to applicable international and national

government regulations.

13. Number of

Kind of Packages

Description of Goods (i.e. Proper shipping name/correct

Net

Gross

Pieces

and Size

technical name. IMO Class/Div. UN, PG Group…)

Weight (kg)

14. Container/Vehicle Identification Number:

15. Seal Number:

16. Container/Vehicle Size:

17. Total Gross

Weight (kg):

18. Emergency Contact, Company Name & Phone Number (International & Domestic):

20. Name of Company Preparing this Document:

19. CONTAINER/VEHICLE PACKING DECLARATION

It is declared that the packing of the container/vehicle has been carried out

in accordance with the applicable provisions.

Name/Status of declarant:

Packing Company Name:

Place and Date:

Signature of declarant:

Signature of Packer:

Imo Dangerous Goods Declaration