Waste Form

							                          INFORMATION ACCOMPANYING SHIPMENTS OF WASTE
                               AS REFERRED TO IN ARTICLE 3(2) AND (4)
Consigment information (1)                                                                         CONTAINER NO. TGHU7957521
1. Person who arranges the shipment:                            2. Importer / Consignee:
Name: FAZAL CLOTH MILLS LIMITED                                 Name: Lüke & Co. GmbH
Address: 129-1, OLD BAHAWALPUR ROAD, MULTAN,                    Address: Märkischer Weg 35-37, D-48282 Emsdetten/Germany
PAKISTAN                                                        Contact person: Mr. Westkamp
Contact person: MR. SHAHID HUSSAIN / DILDAR HUSSAIN             Tel.: 0049 2572 932012 Fax: 0049 2572 932020
Tel.: 92-61-4587632 Fax: 92-61-4541832                          E-Mail: westkamp@lueke-co.de
E-Mail: info@fazalcloth.com – shahid@fazalcloth.com –
dildar@fazalcloth.com
3. Actual quantity:               (kg): 24850 Kgs               4. Actual date of shipment: 21-09-2012
                                    m³:
5.(a) 1. First carrier (2):               5.(b): 2. Second carrier:                       5.(c): 3. Third carrier:
Name: SAMSKIP GmbH                        Name:                                           Name:                            .
Address: Konsul-Smidt-Str. 82, D-28217    Address:                                        Address:                         .
Bremen/Germany                            Contact person:                                 Contact person:                  .
Contact person: Mr. Kempski               Tel.:                                           Tel.:                            .
Tel.: 0049 421 3047 523                   Fax:                                            Fax:                             .
Fax: 0049 421 3047 530                    E-Mail:                                         E-Mail:                          .
E-Mail: henryk.kempski@samskip.com        Means of transport:                             Means of transport:              .
Means of transport: INTERMODAL            Date of transfer:                               Date of transfer:                .
Date of transfer:
                                          Signature:                                      Signature:
Signature:
6. Waste generator (3)                                          8. Recovery operation (or if appropriate disposal operation in
Original producer (s), new producer (s) or collector:           the case of waste referred to in Article 3 (4)):
Name: FAZAL CLOTH MILLS LIMITED                                 R-code / D-code: R3                                        .
Address: 129-1, OLD BAHAWALPUR ROAD, MULTAN,
PAKISTAN                                                        9. Usual description of the waste:
Contact person: MR. SHAHID HUSSAIN / DILDAR HUSSAIN              cotton waste                                              .
Tel.: 92-61-4587632 Fax: 92-61-4541832                                                                                     .
E-Mail: info@fazalcloth.com – shahid@fazalcloth.com –
dildar@fazalcloth.com
7. Recovery facility                Laboratory                  10. Waste identification (fill in relevant codes):
Name: Lüke & Co. GmbH
                                                                 i) Basel Annex IX :                    B 3030             .
Address: Märkischer Weg 35-37, D-48282 Emsdetten/Germany
                                                                 ii) OECD (if different from (i)):                         .
Contact person: Mr. Westkamp
                                                                 iii) EC list of wastes:                                   .
Tel.: 0049 2572 932012 Fax: 0049 2572 932020
                                                                 iv) National code:                     52029900           .
E-Mail: westkamp@lueke-co.de
11. Countries/states concerned:
        Export / dispatch                                       Transit                                   import / destination
Pakistan                                                                     .                 . Germany                              .
12. Declaration of the person who arranges the shipment: I certify that the above information is complete and correct to my best
knowledge. I also certify that effective written contractual obligations have been entered into with the consignee (not required in the
case of waste referred to in Article 3(4)):

Name: M.D. KANWAR , COMPANY SECRETARY                               Date:16-09-2012                 .Signature:
13. Signature upon receipt of the waste by the consignee:

Name:                                            . Date:                                       .Signature:

                  TO BE COMPLETED BY THE RECOVERY FACILITY OR BY THE LABORATORY:
14. Shipment received at recovery facility:                                  Quantity received:                                    (kg):                            .
    or laboratory:                                                                                                                  m³:                             .
Name:                                            . Date:                                       .Signature:




(1)   Information accompanying shipments of green listed waste and destined for recovery or waste destined for laboratory analysis pursuant to Regulation (EC) No
      1013/2006.
(2)   If more than three carriers, attach information as required in blocks 5 (a), (b) and (c).
(3)   When the person who arranges the shipment is not the producer or collector, information about the producer or collector shall be provided.