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DoormanDangerous Good Declaration

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1) Shipper

2) Reference number (s)
e.g. bill of lading No..
customers reference No. or other

3) Consignee

4) Carrier

Container packing certificate/vehicle declaration.
DECLARATION:
It is declared that the packing of the container/vehicle has been carried out in accordance with the General introduction, IMDG Code, paragraph 12.3.7 or 17.7.7

TO BE COMPLETED FOR SHIPMENTS IN CONTAINERS OR VEHICLES

5) Name/status, company/organization of signatory

Place and date:

Signature on behalf of packer



_______________________

Vessel & voyage

6) Port of Loading

7) Additional Information

8) Port of Discharge

9) Goods delivered as:

 

Marks & numbers

Number and kind of packages

Unit Quantity**

Gross Mass (kg)**

Cubic Vol. (m3)

Type of unit:

*Proprietary/trade names alone are not sufficient. If applicable:

(1) the word 'WASTE' should precede the name;
(2) 'EMPTY UNCLEANED' or 'RESIDUE - LAST CONTAINED' should be added';
(3) 'LIMITED QUANTITY' should be added.
** When required in 9.3 of the General introduction to the IMDG Code;
*** When required

10) ADDITIONAL INFORMATION
In certain circumstances special information/certificates are required, see IMDG Code, General Introduction, paragraphs 9.7.1/9.7.2.
Any additional information should be entered in section 7 above, overleaf or attached to this form

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 labelled/placarded, and are in all respects in proper condition for transport according to the applicable international and national government regulations.

Yours faithfully

Signatory's Company: ____________________________________

11) Name of authorised signatory

Place and date of issue

Signature for and on behalf of shipper

Email:*


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