Fillable Printable Shipper's Application for Dangerous Goods

Shipper's Application for Dangerous Goods

SHIPPER'S DECLARATION FOR DANGEROUS GOODS

Shipper

Air Waybill No.

Page of Pages

Shipper's Reference Number

(optional):

Consignee

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

Airport of Destination:

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. This Declaration

must not, in any circumstances, be completed and/or

signed by a consolidator, a forwarder or an IATA cargo

agent.

Shipment type: (delete non-applicable)

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods Identification

Proper Shipping Name

Class

Divi-

sion

No.

Pack-

ing

group

Subsi-

diary

Risk

Quantity and

type of packing

Packing

Inst.

Authorization

Additional Handling Information

24 hr. Emergency Contact Tel. No.: shipment is made under the provisions of ICAO

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.

Name/Title of Signatory

Place and Date

Signature

(see warning above)