Pharmaceuticals Hazardous Materials Declaration
1. Shipper and Consignee Information
Shipper Name
Consignee Name
Shipper Address
Consignee Address
2. Product Information
Product/Drug Name
UN Number
Proper Shipping Name
Quantity
Packaging Type
Classification (e.g., 6.1, 3)
Packing Group
I
II
III
3. Declaration
Name of Person Making Declaration
Date
Signature
Remarks