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Shipper
voy
s/o no.
contr no. :
place of receipt
place of delivery
ship's operator
port of loading
port of discharge
container operators
CLASS:
no of packages:
total weight
total gross wt:
Technical name:
UN.NO
UN IIP code:
Flash point:
Marine Pollutant:
properties
Inner packing:
label
toxicity
packing group
ld/tlv
emergency
prevention
procedures
measures
protection
specific
ignition
gravity
point
reactivity/other haz
equipments
medical
first aid
emergency communication : PIC NAME & NO
I hereby declare that the contents of this consignment
I Hereby Certify that
1.The container was clean, dry and apparently fit to receive goods.
4.All packages have been properly packed in the container and secured
governmental regulations
6. When solid carbon dioxide(dry ice) is used for cooling purposes, the
7. The dangerous goods declaration required in sub section 9.4 of the general
introduction to the International Maritime dangerous goods(IMDG)code has
Signature of Shipper
Page 1
________________________________
DATE :