Shippe'rs Name & Address

Consignee's Name & Address Ship's Stowage Location

Ocean Vessel Voy No. S/O No.

Container No.

Place of Receipt Place of Delivery Ship's Operator Container Operator

Port of Loading Port of Discharge Vanning Survey Req Not Req

Marks & No. Proper Shipping Name IMDG Class

UN No. Large Package

Commodity Yes No

Subsidiary Risk Limit Quantity

Yes No

Inner Packaging/Quantity/Capacity Packing Group Excepted Quantity

Yes No

Total Weight Flash Point

Outer Packaging/Quantity/Capacity (Gross/Net)(Kg) Centigrade: Fahrenheit:

Net: Marine Pollutant

Yes No

Gross: EMS TAB No.

Properties Appearance Odour Specific Ignition Toxicity Reactivity and/or Other Hazard

Gravity Point (LD/TLV)

Emergency Prevention Measures

Procedures

Protection Equipment

Medical First Aid

Emergency Communication :

I hereby certify that: I hereby declare that the contents of this consignment

1.The container was clean, dry and apparently fit to receive goods. are fully and accurately described above by proper

2.No incompatible substances have been packed into the container. shipping name and are classified, packed, marked

3.All packages have been externally inspected for damage, leakage or sifting, and labelled ,and are in all respects in proper

and only sound packages have been loaded. condition for transportation by sea ,land, according

4.All packages have been properly packed in the container and secured to applicable in international & national

5.The container and packages are properly marked and labelled. governmental regulations

6. When solid carbon dioxide(dry ice) is used for cooling purposes, the This is to certify that the above-named materials

container is externally marked or labelled in a conspicious place at the are properly classified, described, packaged, marked,

door end reading . " DANGEROUS CO2 - GAS (DRY ICE) INSIDE." VENTILATE and labelled , and are in proper condition for

THOROUGHLY BEFORE ENTERING. transportation according to the applicable

7. The dangerous goods declaration required in sub-section 9.4 of the general regulation of the Department of Transportation.

introduction to the International Maritime Dangerous Goods(IMDG) code has

been received for each dangerous goods consignment packed in the Signature of Shipper

container.

8.If the consignment include goods of class 1.except division 1.4.

The vehicle container is structurally serviceable in conformity with

section 12 of the introduction to class 1 of the IMDG Code. DATE (yy/mm/dd) :

9. When dangerous goods are transported in bulk packagings, the

cargo has been evenly distributed.

IBC

Yes No

DECLARATION OF DANGEROUS GOODS

DANGEROUS PACKING CERTIFICATE

WHPOBD201202