Hazardous Material Marine Cargo Declaration
Shipper/Consignor/Sender
Carrier (To be completed by the Carrier)
Booking Reference No.
B/L or AWB No.
Consignee
Vessel/Flight No. & Date
Port of Loading
Port of Discharge
Final Destination
Cargo Details
Container No./Vehicle Registration No.
Seal Number(s)
Marks & Numbers
No. & Kind of Packages; Description of Goods
Class or Division
UN Number
Packing Group
Flashpoint (°C)
Marine Pollutant
EMS No.
Net Weight (kg)
Net Explosive Content (kg)
Gross Weight (kg)
Total Quantity & Type of Packing
Additional Information / Special Handling Instructions
Certification
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.
Name/Status of Declarant
Place/Date
Signature