Hazardous Materials Shipping Declaration

Shipper Information

Shipper Name

Address

Contact Number

Consignee Information

Consignee Name

Address

Contact Number

Shipment Details

Carrier

Airway Bill / Tracking No.

Date

Hazardous Materials Information

Proper Shipping Name	UN Number	Class/Division	Packing Group	Quantity & Type of Packing

Emergency Contact

Emergency Contact Name

Emergency Phone Number

Relationship

Additional Information

Shipper's Signature

Date