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 correct technical names(s), proper shipping name(s) and are classified, packaged, marked, and labeled/placard, and are in all respects in proper condition for transport according to the 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. Emergency Contact , Company Name & Phone Number (International & Domestic):

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: TC2 Provided by International Forwarders, Inc.

Your Global Logistics Partner

IMO Dangerous Goods Declaration without CPC

Taylor Cottrell

2003-06-23

International Forwarders, Inc.