Fillable IMO DANGEROUS GOODS DECLARATION (ShipMate)

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IMO DANGEROUS GOODS DECLARATION (ShipMate)

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Country of origin: US
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IMO DANGEROUS GOODS DECLARATION
1 Shipper/Consignor/Sender 2 Transport Document Number
3 Page of pages 4 Shipper's Reference
6 Consignee 5 Freight Forwarder's Reference
7 Carrier (to be declared by the Carrier)
10 Vessel/Flight & Date 9 Additional Handling Information
11 Port/Place Handling
14 Shipping Marks *Number & Kind of Packages, Description of Goods GW (kg) CUBE (m
3
)
15 CTU ID No. 16 Seal No. 17 CTU Size & Type 18 Tare Mass (kg) 19 Total Gross Mass (kg)
21 Receiving Organization Receipt
20 Name of Company Hauler's Name 22 Name of Company Preparing Note
Name/status of Declarant Vehicle Registration No. Name/Status of Declarant
Place and Date Driver Name and Date Place and Date
Signature of Declarant Driver's Signature Signature of Declarant
STYLE F03L © 2003 (800) 621-5808 www.labelmaster.com
®
SHIPPER'S DECLARATION
CONTAINER / VEHICLE PACKING CERTIFICATE
Received the above number of packages/containers/trailers in apparent good order
and condition, unless stated hereon:
RECEIVING ORGANIZATION REMARKS:
I hereby declare that the goods described above
have been packed/loaded into the
container/vehicle
identified above in accordance with the applicable
provisions of IMDG code 5.4.2.
MUST BE COMPLETED AND SIGNED FOR ALL
CONTAINER/VEHICLE LOADS BY PERSON RESPONSIBLE
FOR PACKING/LOADING
I hereby declare that the contents of this consignment are fully and accurately described below 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 applicable international and national
governmental regulations.
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IMO DANGEROUS GOODS DECLARATION (ShipMate)

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Completed 1 April 2021

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