Hazardous Material Import/Export Declaration
1. Exporter / Importer Details
Company Name
Contact Person
Email
Phone
Address
Country
City
2. Shipment Details
Declaration Type
Import
Export
Date
Shipment Number
Country of Origin
Destination Country
Port of Entry/Exit
3. Hazardous Material Information
Material Name
UN Number
Hazard Class
Quantity
Unit
Packaging Type
Material Description
4. Supporting Documents
Manifest Number
License / Permit Number
Other Documents
5. Declaration
Declarant Name
Position/Title
Signature
Date