Toxic Substances Maritime Transport Manifest
Shipper Information
Company Name
Address
Contact Person
Phone
Consignee Information
Company Name
Address
Contact Person
Phone
Voyage Details
Vessel Name
IMO Number
Departure Port
Destination Port
Departure Date
Estimated Arrival Date
Manifest Details
#
Substance Name
UN Number
Class
Packing Group
Quantity
Packaging Type
Container Number
Emergency Contact
1
2
3
Special Handling Instructions
Additional Notes
Date
Authorized Signature