SHIPPER’S DECLARATION FOR DANGEROUS GOODSShipper Air Waybill No.

Page of PagesShipper’s Reference Number　　　　　 (optional)

Consignee

Two completed and signed copies of this Declaration

must

be handed to the operator.

WARNING

TRANSPORT DETAILS Failure to comply in all respects with the applicableDangerous Goods Regulations may be in breach ofthe applicable law , subject to legal penalties.

This shipment is within the

limitations prescribed for :

(delete non-applicable)

PASSENGE

R

AND

CARGO

AIRCRAFT

CARGO

AIRCRA

FT

ONLY

Airport of Departure

Airport of Destination :Shipment type : (delete non-applicable)

NON-

RADIOACTIVE

RADIOACTI

VE

NATURE AND QUANTITY OF DANGEROUS GOODS (see sub-Section 8.1 of IATA Dangerous Goods Regulations)

Dangerous Goods Identification

Quantity andtype of packing

Packinglnst.

Authorization

UNorIDNO.

Proper Shipping Name

Classor

DivisionSubsidiar

yRisk

Pack-ingGroup

Additional Handling Information

24-hour emergency telephone number : (including country and area code)

I hereby declare that the contents of this consignment are fully andaccurately described above by the proper shipping name , and areclassified , packaged , marked and labeled/placarded , and are in allrespects in proper condition for transport according to applicableinternational and national govermmental regulations. I declare thatall of the applicable air transport requirements have been met.

Name/Title of Signatory

Place and Date

Signature(See warning above)

TS-DG301 (JAN/2005)