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					                                                             TEAMGLOBAL LOGISTICS PVT LTD




DECLARATION OF DANGEROUS GOODS FOR                                                          DECLARATION OF DANGEROUS GOODS IN CONTAINER &
MULTIMODAL TRANSPORT                                                                        CONTAINER PACKING CERTIFICATE FOR MULTIMODAL
                                                                                            TRANSPORT
This form may be used as a dangerous goods declaration as it meets the requirements of SOLAS 74, chapter VII regulation 5 MARPOL 73/78, Annex III,
                             2

Shipper/ Consignor/ Sender                                                                        1 Transport document number                                    2
                                                                                                    Page 1            3 Shipper's reference                      4
                                                                                                    of
                                                                                                    pages
                                                                                                                         Freight forwarder's reference           5
Consignee                                                                                         6
                                                                                                    Carrier (to be completed by the carrier)                     7




                                                                                                 Name / status company / organization of signatory              22
I hereby declare that the contents of this consignment are fully and accurately described
by the proper shipping name, and are classified packaged, marked and labelled /
placerded and are in all respects in proper condition for transport according to the             Place and date
applicable international and national government regulations.
                                                                                                 Signature on behalf of shipper
This shipments is within the limitations prescribed for : (Delete non-applicable)            8
PASSENGER AND CARGO AIRCRAFT              CARGO AIR CRAFT ONLY
Vessel / flight No. / Voy.No. and loading date                                              10 Prevention Measures, Ems No., Medical First Aid.                  9



                                                                                                 Emergency Communication
                                    Port/ place of loading                                  11

                                                    JNPT                                         Additional handling information
Port / place of discharging      12 Destination                                             13



Shipping Marks                      *description of goods Number and kind of packages                Gross mass (kg)       Net Mass (kg)     Cube (mt)          14




                                    CLASS                :
                                    UN No.               :
                                    PACKING             :
                                    GROUP




Container identification No.
                          15 Seal No.                                               16                               & Tare         18
                                                                                            Container / vehicle size 17 type mass (kg) Total gross              19
                                                                                                                                             (Including tare)
                                                                                                     LCL                                     (kg)

CONTAINER / VEHICLE PACKING CERTFICATE
I hereby declare that the goods described above have been packed / loaded into              RECEIVING ORGANIZATION RECEIPT                                       21
the container / vehicle identified above in accordance with the applicable                  Received the above number of packages/ containers/ trailers in apparent good
provisions. **                                                                              order and condition unless stated hereon: RECEIVING ORGANIZATION
MUST BE COMPLETED AND SIGNED FOR ALL CONTAINER / VEHICLE LOADS BY                           REMARKS
PERSON RESPONSIBLE FOR PACKING / LOADING



Name of the Company                                                                         Haulier's name                 * DANGEROUS GOODS :
                                                                                    20                                     You must specify proper shipping name,
                                                                                                                           hazard class, UN No. packaging group,
Name / status of declarant                                                                                                 (where assigned) division No., Subsidairy
                                                                                            Vehicle reg. No.               hazard class, Marine polluant and observe
                                                                                                                           the mandatory requirements under
Place and date                                                                                                             applicable national and international
                                                                                            Signature and date             governmental regulations. For the purpose
                                                                                                                           of the IMDG Code see Chapter 5.4.1.1
                                                                                                                           IMDG Code page number should not
                                                                                                                           appear on this form

				
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posted:11/28/2011
language:English
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