Automotive Hazardous Materials Shipping Declaration
Shipper Name
Shipper Address
Consignee Name
Consignee Address
Date
Shipment Details
Description of Goods
UN Number
Class/Division
Packing Group
Quantity
Packaging Type
Emergency Contact Name
Emergency Contact Phone
Declaration
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 government regulations.
Shipper Signature
Date