Maritime Hazardous Materials Declaration

Shipper Details

Name

Address

Contact Number

Consignee Details

Name

Address

Contact Number

Cargo & Transport Information

Vessel Name

Booking/BL Number

Voyage No.

Port of Loading

Port of Discharge

Hazardous Materials Information

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

Emergency Contact Name

Emergency Contact Phone

Certification

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 labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations.

Shipper's Signature

Date