Shipper
Consignee
WARNING
Failure to comply in all respects with the applicable
Dangerous Goods Regulations may be in breach of the
applicable law, subject to legal penalties.
Two completed and signed copies of this Declaration must be handed to the operator.
TRANSPORT DETAILS
This shipment is within the limitations
prescribed for:
(delete non-applicable )
Airport of Departure (optional):
PASSENGER AND
CARGO AIRCRAFT
CARGO
AIRCRAFT ONLY
Shipment type: (delete non-applicable)
NON-RADIOACTIVE RADIOACTIVE
Airport of Destination (optional):
NATURE AND QUANTITY OF DANGEROUS GOODS
Dangerous Goods Identification
UN or
ID No.
Proper Shipping Name
Class or Division
(subsidiary hazard)
Packing
Group
Quantity and Type of Packing
Packing
Inst.
Authorization
Additional Handling Information
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 applicable international and national governmental
regulations. I declare that all of the applicable air transport requirements have
been met.
Name of Signatory
Date
Signature
(See warning above)
Air Waybill No.
Page of Pages
Shipper’s Reference No.
(optional)
SHIPPER’S DECLARATION FOR DANGEROUS GOODS
XXX
XXXXXXXXXXX