IMDG Code Compliant Hazardous Manifest Form
Shipment Details
Shipper/Consignor/Sender Name
Address
Contact Number
Consignee Name
Address
Contact Number
Transport and Vessel Information
Vessel Name
Voyage Number
Port of Loading
Port of Discharge
Place of Delivery
Dangerous Goods Information
Proper Shipping Name
UN Number
Class/Division
Packing Group
Marine Pollutant
Quantity & Kind of Packaging
Container Number
Additional Information
Emergency Contact & Certification
Emergency Contact Name
Emergency Contact Number
Certification: "I 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 the applicable international and national government regulations."
Name of Person Signing
Date
Signature