MULTIMODAL DANGEROUS GOODS FORM - turkloydu.org

1 MULTIMODAL DANGEROUS GOODS form 1. Shipper/Consignor/Sender (full style address is mandatory) 2. transport document numberBOOKING REFERENCE: 3. Page of pages 4. Shipper's reference 5. Freight forwarder's reference 6. Consignee (full style address is mandatory) 7. Carrier SHIPPER'S DECLARATION I hereby declare that the contents of this consignment are fully and accurately described below by the Proper Shipping Name, and are classified, packaged, marked and labelled/ placarded and are in all respects in proper condition for transport according to the applicable international and national government regulations.

2 8. This shipment is within the limitations precribed for : 9. Additional handling information (Delete non-applicable)PASSENGER AND CARGOCARGO AIRCRAFTAIRCRAFTONLY 10. Vessel/Flight No. and date 11. Port/place of loading 12. Port/place of discharge 13. Destination 14. Shipping marks* Number and kinds of packages; description of goodsGross mass (Kg) Net Mass (Kg)Cube (m3)UNNO:PROPER SHIPPING NAME::IMO ( sub risk, if any) *:PACKAGING GROUPFLASH POINT ( DEG C):NO/TYPE OF INNER PACKAGING:NET/GROSS CARGO WT:MARINE POLLUTANT:EMERGENCY CONTACT (24 HRS): 15.

3 Container identification 16. Seal number(s) 17. Container/vehicle size & 18. Tare mass 19. Total gross mass (including tare) vehicle registration No. type (Kg) (Kg) CONTAINER/VEHICLE PACKING CERTIFICATE 21. RECEIVING ORGANIZATION RECEIPT I hereby declare that the GOODS described above have been packed/loaded into the Received the above number of packages/containers/trailers in apprent good order and container/vehicle identified above in accordance with the applicable provisions. ** condition, unless stated hereon; RECEIVING ORGANIZATION REMARKS: MUST BE COMPLETED AND SIGNED FOR ALL CONTAINER/ VEHICLE LOADS BY PERSON RESPONSIBLE FOR PACKING/ Training Certificate No:Name of the Port:Packager Training Certificate No: 20.

4 Name of company (stamp and signature are mandatory)Haulier's name 22. Name of company (OF SHIPPER PREPARING THIS NOTE)Container/Vehicle/Vagon reg. No. Name/status of declarant Name/status of declarantSignature and date Place and date Place and dateCarrier Training Certificate No: Signature of declarant DRIVER'S SIGNATURE Signature of declarantSender/ Consignor/Shipper Training Certificate No:Driver Training Certificate No: * DANGEROUS GOODS : You must specify: Proper Shipping Name, hazard class, UN No, packing group (where assigned) marine pollutant and observe the mandatory requirements under applicable national and international governmental regulations.

5 For the purpose of the IMDG Code see ** For the purpose of the IMDG Code, see Code1. Shipper/ Consignor/ Sender2. transport document number3. Page of pages 4. Shipper's reference5. Freight Forwarders' reference14. Shipping marks Gross mass (kg)Net mass (kg)Cube (m3)UNNOPROPER SHIPPING NAME:IMO ( sub risk, if any) *PACKAGING GROUPI / II / IIIFLASH POINT ( DEG C)NO/TYPE OF INNER PACKAGINGNET/GROSS CARGO WTMARINE POLLUTANTEMERGENCY CONTACT (24 HRS)UNNOPROPER SHIPPING NAME:IMO ( sub risk, if any) *PACKAGING GROUPI / II / IIIFLASH POINT ( DEG C)NO/TYPE OF INNER PACKAGINGNET/GROSS CARGO WTMARINE POLLUTANTEMERGENCY CONTACT (24 HRS)UNNOPROPER SHIPPING NAME.

6 IMO ( sub risk, if any) *PACKAGING GROUPI / II / IIIFLASH POINT ( DEG C)NO/TYPE OF INNER PACKAGINGNET/GROSS CARGO WTMARINE POLLUTANTEMERGENCY CONTACT (24 HRS) * DANGEROUS GOODS :You must specify: Proper Shipping Name, hazard class, UN No, packing group (where assigned) marine pollutant and observe the mandatory requirementsunder applicable national and international governmental regulations. For the purpose of the IMDG Code see ** For the purpose of the IMDG Code, see