Emergency Marine Hazardous Materials Manifest

Vessel Information

Vessel Name

IMO Number

Call Sign

Flag State

Operator

Contact Number

Voyage Information

Departure Port

Destination Port

ETA

Date of Departure

Master's Name

Master's Signature

Hazardous Material Details

No.	Proper Shipping Name	UN Number	Class/Division	Packing Group	Quantity & Unit	Container/Package No.	Stowage Location	Emergency Contact

Additional Notes / Special Instructions

Prepared by

Name

Date

Signature