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Get Dangerous Goods Declaration Form

IMO DANGEROUS GOODS DECLARATION This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 ANNEX III regulation 4 and the IMDG CODE General introduction section 9 Shipper Reference number s Page 1 of 1 Shipper s Reference Number Consignee Container packing certificate/vehicle declaration Carrier Name/status company/organization of signatory DECLARATION Place and date It is declared that the packing of the container/vehicle has been carried out in accordance with the General Introduction IMDG Code paragraph 5. 4. 2 Signature on behalf of packer TO BE COMPLETED FOR SHIPMENTS IN CONTAINERS OR VEHICLES Ship s name and voyage No* Port of loading Instructions or other matter Port of discharge Marks Nos. If applicable identification or registration number s of the Unit Number and kind of packages proper shipping name IMO hazard class/division UN number packaging group where assigned flashpoint in C. c*c* control and emergency temperatures MFAG Table No* Gross mass kg net quantity/mass Goods delivered as Breakbulk cargo Unitized Bulk packages Type of unit container trailer tank vehicle etc* Open Closed Insert X in approriate box Synonyms should not be used* Proprietary/trade names alone are not sufficient. If applicable 1 the word WASTE should precede the nam 2 EMPTY UNCLEANED or RESIDUE-LAST CONTAINED should be added 3 LIMITED QUANTITY should be added* This column may be left empty apart from the heading in which case insert appropriate description When required in paragraph 9. 3 of the General Introduction to the IMDG code When required* The IMDG Code page number should not appear on this form* ADDITIONAL INFORMATION In certain circumstances special information/certificates are required see IMDG code General Introduction paragraphs 9. 7. 1/9. 7. 2/9. 9. 1 and 9. 10. 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. 4. 2 Signature on behalf of packer TO BE COMPLETED FOR SHIPMENTS IN CONTAINERS OR VEHICLES Ship s name and voyage No* Port of loading Instructions or other matter Port of discharge Marks Nos. If applicable identification or registration number s of the Unit Number and kind of packages proper shipping name IMO hazard class/division UN number packaging group where assigned flashpoint in C. If applicable identification or registration number s of the Unit Number and kind of packages proper shipping name IMO hazard class/division UN number packaging group where assigned flashpoint in C. c*c* control and emergency temperatures MFAG Table No* Gross mass kg net quantity/mass Goods delivered as Breakbulk cargo Unitized Bulk packages Type of unit container trailer tank vehicle etc* Open Closed Insert X in approriate box Synonyms should not be used* Proprietary/trade names alone are not sufficient. .

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