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Dangerous Goods Declaration

For Vessel and Interlining Intermodal Transport

PDF form

Dangerous Goods Declaration

Shipper/Consignor/Sender of Record

Consigneе

Carrier (to be completed by carrier)

Transport document no.

Booking no.

Shipper's reference

Freight Forwarder's reference

Vessel Name and voyage

Place of receipt

Port/place of loading

Port/place of discharge

Place of Final Destination

Emergency contact phone (w/ intemational access code)

Additional handling information

Placards/Signs

Goods

Description of Goods (IMDG Code 5.4.1.1)

Shipping marks

No. of Pkgs.

Type of Pkgs.

Gross mass (kg)

Net Explosive Qty.(class 1 only)

Seal no.

Identification noVehicle/Container

Size & typeVehicle/Container

Tare mass (kg)

Total gross including tare (kg)

Container/Vehicle packing certificate

Must be completed and signed for all container/vehicle loads (other than tanks) by the person responsible for packing/loading per 5.4.2.1.

It is declared that the packing of the goods into the container/vehicle identified above has been carried out in accordance with the applicable provisions.

Name of company packing container *

Name/status of declarant *

Place container/vehicle packed *

Date packed *

Signature of declarant *

Draw your signature between the lines

Shipper's declaration

Must be completed and signed for all dangerous goods consignments by the person responsible for offering the dangerous goods for transport per IMDG code 5.4.1.1.11.

I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labelled/placarded and are in all respects in proper condition for transport according to the applicable international and national governmental regulations.

Name of company of shipper *

Name/status of declarant *

Place of signature *

Date of signature *

Signature of declarant *

Draw your signature between the lines