IMO DANGEROUS GOODS DECLARATION

1. Shipper:

2. Transport Document Number:
3. Page 1 of pages
4. Shipper’s Reference:
5. Freight Forwarders Reference:

6. Consignee:

7. Carrier:

8. Additional Handling Information:

9. Ship’s name / Voyage #:

10. Port of Loading:

11. Port of Discharge:

SHIPPER’S DECLARATION

“I hereby declare that the contents of this consignment are fully and accurately described below by the Proper Shipping name(s) and are classified, packaged, marked, and labelled/placarded, and are in all respects in proper condition for transport according to applicable international and national government regulations.
12. On Carriage:

13. Number

of Pieces

Kind of Packages

and Size

Description of Goods (i.e., UN #, Proper shipping name/correct

technical name. IMO Class/Div., Subsidiary Risk, PG Group…)

Net

Weight (kg)

Gross

Weight (kg)

14. Container/Vehicle Identification Number:

15. Seal Number:

16. Container/Vehicle Size:

17. Total Gross

Weight (kg):

18. Emergency Contact , Company Name & Phone Number (International & Domestic):

19. CONTAINER/VEHICLE PACKING DECLARATION

It is declared that the packing of the container/vehicle has been carried out in accordance with the applicable provisions.

Packing Company Name:

Place and Date:

Signature of Packer:

20. Name of Company Preparing this Document:

Name/Status of declarant:

Place and Date:

Signature of declarant:

1. Shipper:

2. Transport Document Number:
3. Page of pages
4. Shipper’s Reference:
5. Freight Forwarders Reference:
13. Number

of Pieces

Kind of Packages

and Size

Description of Goods (i.e., UN #, Proper shipping name/correct

technical name. IMO Class/Div., Subsidiary Risk, PG Group…)

Net

Weight (kg)

Gross

Weight (kg)

IFI Form: TC1 Provided by International Forwarders, Inc.

Your Global Logistics Partner

IMO Dangerous Goods Declaration with CPC

Taylor C Cottrell III

2003-06-23

Taylor Cottrell

International Forwarders, Inc