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Imo Dangerous Goods Declaration

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Pages

IMO DANGEROUS GOODS DECLARATION

1 Shipper

2 Transportation Document Number

4 Shipper's Reference

PAGE

6 Consignee

5 Freight Forwarder's Reference

Carrier:

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)