Gross Nett

Please enter the The number of The type of packages Weight of Weight ofcontainer numbers packages of haz of haz cargo in the the haz the hazand seal numbers cargo in the container cargo in the cargo in the

container container container

UN No. EMS

IMCO Class MFAG No.

Marine Pollutant Flash Point

Packaging Group Packaging Code

IMO DANGEROUS GOODS DECLARATION & CONTAINER PACKING CERTIFICATEThis form meets the requirement of SOLAS 74 chapter VII, regulation 5;

MARPOL 73/78 ANNEX III, regulation 4 and the IMDG CODE, General introduction, section 9Shipper Lines Booking Reference Lines DG Acceptance Reference

This field should display the name of the actual shipper of the cargo Booking reference received from the

shipping line

Reference number of the DG acceptance from

the line after the DG Request is approvedShippers Reference

Any reference number of the shipper

Consignee Other Reference

This field should display the name of the actual consignee of the cargo Any other reference number(s) of the shipper or freight forwarder

Name of Carrier

Name of the Shipping Line that will be carrying the cargo

Container packing certificate/vehicle declaration

DECLARATION

It is declared that the packing of the container/vehicle has been carried

out in accordance with the General Introduction, IMDG Code, paragraph

5.4.2

TO BE COMPLETED FOR SHIPMENTS IN CONTAINERS OR VEHICLES

Emergency Contact Details for Shipper in case of emergencies

Ship's name and voyage No.

Name and voyage number of the ship performing the carriage of this hazardous cargo

Port of Loading Port of Discharge

Port of Loading Port of Discharge

Actual description of cargo and the proper shipping name -

Example : Paint instead of Dulux or

Varnish instead of Woodoc or

Heptafluoropropane instead of just Environmentally hazardous substance n.o.s

All relevant hazardous information outlined below UN No., IMO Class, Marine Pollutant,

Packaging Group, EMS, MFAG no., Flash Point, Packaging Code must be fully and

properly filled as this is the main information that is requried

EMS - is Emergency Medical Schedule which provides information to Emergency

personnel on how to handle the emergency

MFAG - is Medical and First Aid Guide which tells the Emergency or on-board personnel

what First Aid is to be administered to the affected party

If you are unclear about the packaging code, please download the packaging codes guide

under the download guides

Hazardous Information Download guides

Number and kind of packages, proper shipping name *, IMO hazard class/division, UN number, packaging group (where assigned) * *, flashpoint (in ºC.c.c.) * *, control and emergency

temperatures * *, identification of the good as MARINE POLLUTANT* *, EmS No. and MFAG Table No.***

Marks & Nos /

Container NosNo. of Packages Type of Packages Cargo Description / Proper Shipping Name

Weights (Kgs)

* Synonyms should not be used. Proprietary/trade names alone are not sufficient. If applicable: ADDITIONAL INFORMATIONDeclaration (required for all dangerous goods): It is further certified that:

It is certified that the goods are packed and stowed in accordance with the 1. The container was clean, dry and fit to receive the goods

sound packages loaded.

container is clearly marked with a label to indicate the classification of the 5. The container and goods are properly labeled.

IMDG rules and are packed and stowed in a manner adequate to withstand 2. No goods known to be incompatible have been allowed therein.

the ordinary risks of handling and transport having regard to the nature 3. All packages have been properly stowed and secured and

of the goods. suitable securing materials have been used

EXPLANATION OF IMO DANGEROUS GOODS DECLARATION & CONTAINER PACKING CERTIFICATE

Signature on behalf of packer

Name and contact details of the person incharge of this shipment - preferably someone

who handles the shipment

Instructions or other matter

goods. In case there are any substances which require separate certificates 6. The dangerous goods in this container are those accepted

these are provided. under the above Booking Reference Number(s)

Name/status, company/organization of signatory

Any other special instructions to be followed during handling either by the shipping line

or the trucker

Here you can download

guides relating to the

filling up of the DG

Goods Declaration

Name of the signatory signing this document on behalf of the shipper Signature and stamp of the shipper's company

Place and Date

Signature and stamp of Shipper

The packages are clearly marked with a distinctive label or stencil to indicate 4. All packages have been inspected for damage and only dry,

the nature of the danger to which the goods give rise, and in addition the

dgdexpl-http://shippingandfreightresource.com-version1-11062012