Export Declaration Form for Hazardous Chemicals
Exporter Name
Exporter Address
Consignee Name
Consignee Address
Intended Country of Import
Details of Hazardous Chemicals
Chemical Name
Chemical Formula
CAS Number
UN Number
HS Code
Quantity
Physical State
Solid
Liquid
Gas
Packing Details
Shipment Date
Additional Information / Remarks
Authorized Signatory
Date