Shipper (Name and Address)
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Reference Number(s)
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(Reserved)
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Name of Carrier (or Carrier's Agent)
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Port/Place of Destination
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Instructions
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Marks and Numbers; Numbers and Kinds of Packages: Description
of Goods* Indicate: Hazard Class/Division; Packaging Group (When
Required),UN Number, Flashpoint ( When Required, in °C); Marine
Pollutant (When Required)
*Proper Shipping Name: Propriety names alone are not sufficient. |
Gross Mass (Kg)
Net Quantity (When Required)
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Declaration:
" I hereby declare that the contents of this consignment
are fully and accurately described above by the correct technical
name(s) (proper shipping name(s)), and are classified, packaged,
marked and labelied , and are in all respects in proper condition
for transport by(insert mode(s) of transport involved) according
to the applicable international and national government regulations"
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Name/Status of Signatory ____________________
Place and Date_____________________________
Signature on Behalf of Shipper_________________ |