Scribd
Upload
88 views2 pages

Fi Freight Multimodal Dangerous Goods Form

Uploaded by

amanihassa277
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
88 views2 pages

Fi Freight Multimodal Dangerous Goods Form

Uploaded by

amanihassa277
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
You are on page 1/ 2

MULTIMODAL DANGEROUS GOODS FORM

This form may be used as a dangerous goods declaration as it meets the requirements of SOLAS 74, chapter VII, regulation 54; MARPOL 79/78,
Annex III, regulation 4.

1 Shipper/Consignor/Sender 2 Transport document number


3 Page 1 of pages 4 Shipper's reference
5 Freight forwarder's reference
6 Consignee 7 Carrier (to be completed by the carrier)
SHIPPER'S DECLARATION
I hereby declare that the contents of this consignment are fully and accurately
described below by the Proper Shipping Name, and are classified, packaged,
marked and labeled/placarded and are in all respects in proper condition for
transport according to the applicable international and national government
regulations.

8 This shipment is within the limiations prescribed for: 9 Additional handling information
(Delete non-applicable)
PASSENGER AND CARGO CARGO AIRCRAFT
AIRCRAFT ONLY

10 Vessel/flight no. and date 11 Port/place or loading

12 Port/place of discharge 13 Destination

14 Shipping marks *Number and kind of package; description of goods Gross mass(kg) Net mass(kg) Cube(m²)

15 Container identification no./ 16 Seal number(s) 17 Container/vehicle size & 18 Tare mass (kg) 19 Total gross mass (including tare)
vehicle registration no. type (kg)

CONTAINER/VEHICLE PACKAGING CERTIFICATE 21 RECEIVING ORGANIZATION RECEIPT


I hereby declare that the goods described above have been Received the above number of packages/ container/ trailers in apparent good order and condition,
packed/loaded into the container/vehicle identified above in unless stated hereon: RECEIVING ORGANIZATION REMARKS:
accordance with the applicable provisions.**

MUST BE COMPLETED AND SIGNED FOR ALL


CONTAINER/VEHICLE LOADS BY PERSON RESPONSIBLE
FOR PACKING/LOADING

20 Name of company Haulier's name 22 Name of company (OF SHIPPER


PREPARING THIS NOTE)

Vechicle reg. no.


Name/status of declarant Name/status of declarant
Signature and date
Place and date Place and date

Signature of declarant DRIVER'S SIGNATURE Signature of declarant

* FOR DANGEROUS GOODS:

You must specify: UN No., Proper Shipping Name, hazard class, packing group, (where assigned), marine pollutant and observe the mandatory requirements under
applicable national and international governmental regulations. For the purposes of the IMDG Code see 5.4.1.4

** For the purposes of the IMDG Code. See 5.4.2


1 Shipper/Consignor/Sender 2 Transport document number
3 Page 1 of pages 4 Shipper's reference
5 Freight forwarder's reference
14 Shipping marks *Number and kind of package; description of goods Gross mass(kg) Net mass(kg) Cube(m²)

You might also like