Dangerous Goods Declaration Form
Consignor/Exporter
Name:
Address:
Phone/Email:
Consignee
Name:
Address:
Phone/Email:
Transport Details
Vessel/Flight No.:
Date of Departure:
Port of Loading:
Port of Discharge:
Dangerous Goods Information
UN Number
Proper Shipping Name
Class/Division
Packing Group
Quantity & Packaging
Additional Information
Emergency Contact Name:
Emergency Tel:
Shipper's Declaration
Name/Title of Signatory:
Place and Date:
Signature: