Marine Pollutant Container Declaration Form
Shipper Name
Contact Number
Date
Container Number
Seal Number
Vessel Name
Voyage Number
Port of Loading
Port of Discharge
Pollutant Details
Proper Shipping Name
UN Number
Class
Packing Group
Marine Pollutant?
Yes
No
Quantity & Packaging
Emergency Contact
Declaration
I hereby declare that the contents of this consignment are fully and accurately described above and 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
Signature
Date