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SHIPPER’S DECLARATION FOR DANGEROUS GOODS Shipper Consignee Air Waybill No. Page of Pages Shipper’s Reference Number (optional) Four completed and signed copies of this Declaration must be handed to the operator. TRANSPORT DETAILS This shipment is within the limitations prescribed for: (delete non-applicable ) Airport of Departure: PASSENGER AND CARGO AIRCRAFT CARGO AIRCRAFT ONLY Shipment type: (delete non-applicable) NON-RADIOACTIVE RADIOACTIVE Airport of Destination: NATURE AND QUANTITY OF DANGEROUS GOODS Dangerous Goods Identification UN or ID No. Proper Shipping Name Class or Division (subsidiary risk) Packing Packing Group Quantity and Type of Packing Inst. Authorization Additional Handling Information Shipment is made under the provisions of ICAO Emergency contact 24-hr number: CHEMTREC (800)4249300 (PAML Acct.) I hereby declare that the contents of this consignment are fully and accurately described above 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 applicable International and National Governmental Regulations. I declare that all of the applicable air transport requirements have been met. Name/Title of Signatory Place and Date Signature (See warning above)

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Page 1: SHIPPER’S DECLARATION FOR DANGEROUS GOODS Shipper … Declaration for Dangerous... · SHIPPER’S DECLARATION FOR DANGEROUS GOODS Shipper Consignee Air Waybill No. Page of Pages

   SHIPPER’S DECLARATION FOR DANGEROUS GOODS

Shipper

Consignee

Air Waybill No.

Page of Pages

Shipper’s Reference Number (optional)

 Four completed and signed copies of this Declaration must be handed to the operator.

TRANSPORT DETAILS

 This shipment is within the limitations   prescribed for:

  (delete non-applicable )

Airport of Departure:

PASSENGER AND CARGO AIRCRAFT

CARGOAIRCRAFT ONLY

Shipment type: (delete non-applicable)

NON-RADIOACTIVE RADIOACTIVE Airport of Destination:

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods Identification

UN or ID No.

Proper Shipping Name Class or Division(subsidiary risk)

Packing PackingGroup   Quantity and Type of Packing Inst. Authorization

 Additional Handling Information Shipment is made under the provisions of ICAO

 Emergency contact 24-hr number:  CHEMTREC (800)424­9300 (PAML Acct.)

 I hereby declare that the contents of this consignment are fully and accurately  described above 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 applicable International and National Governmental  Regulations. I declare that all of the applicable air transport requirements have  been met.

Name/Title of Signatory

Place and Date

Signature (See warning above)

Shipper’s Perspective Global Trade

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