Fillable SHIPPERS DECLARATION I hereby declare that the contents (ShipMate)

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SHIPPERS DECLARATION I hereby declare that the contents (ShipMate)

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2 Transport Document Number
1 Shipper / Consignor / Sender
3 Page X of Y Pages
4 Shipper’s Reference
5 Freight Forwarder’s Reference
6 Consignee
7 Carrier (to be declared by the carrier)
SHIPPER’S DECLARATION
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 the applicable international and national governmental regulations.
8 This shipment is within the limitations prescribed
for: (delete non-applicable)
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
10 Vessel / Flight & Date
11 Port / Place handling
12 Port / Place discharge
13 Destination
9 Additional handling information
14 Shipping Marks * Number & Kind of Packages; Description of Goods GW (kg) NW (kg) VOL (m
3
)
15 Container ID No./
Vehicle Reg. No.
16 Seal Numbers
16 Container / Vehicle
Size / Type
18 Tare Mass (kg)
19 Total Gross Mass
(including Tare) (kg)
CONTAINER PACKING CERTIFICATE
I hereby declare that the goods described above have
been packed/loaded into the container identified above in
accordance with the applicable provisions of section 5.4.2
of the IMDG Code.
21 Receiving Organization Receipt
Received the above number of packages/containers/trailers in apparent
good order and condition, unless stated hereon:
RECEIVING ORGANIZATION REMARKS:
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 / Date
Place / Date
Place / Date
Signature of Declarant
Driver’s Signature
Signature of Declarant
* Use the term "OVERPACK USED" when packages are overpacked. ShipMate, Inc., 1-310-370-3600, www.shipmate.com
FRED SAPIENZA
17
ShipMate, Inc. +1 (310) 370-3600 http://www.shipmate.com
REQUIRED EQUIPMENT FOR THE VEHICLE:
FOR EACH MEMBER OF THE VEHICLE CREW
MARKING OF THE VEHICLE:
INSTRUCTIONS IN WRITING FOR THE DRIVER
LOAD
ShipMate, Inc. +1 (310) 370-3600 http://www.shipmate.com
ACTIONS IN THE EVENT OF AN ACCIDENT OR EMERGENCY:
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Completed 1 April 2021

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