SHIPPER'S DECLARATION FOR DANGEROUS GOODS
| Shipper | Air Waybill No. Page of Pages Shipper's Reference Number (optional) | ||||||||||||
| Consignee | For optional use for Company logo name and address | ||||||||||||
| Two completed and signed copies of this Declaration must be handed to the operation | WARNING Failure to comply in all respects with the applicable Dangerous Goods Regulations may be in breach of the applicable law, subject to legal penalties. This Declaration must not, in any circumstances, be completed and/or signed by a consolidator, a forwarder or an IATA cargo agent. | ||||||||||||
| TRANSPORT DETAILS | |||||||||||||
| This shipment is withhin the limitations prescribed for. (delete non-applicable) | Airport Of Departure | ||||||||||||
| PASSENGER AND CARGO AIRCRAFT | CARGO AIRCRAFT ONLY | ||||||||||||
| Airport of Destination: | Shipment type (delete non-applicable) | ||||||||||||
| NON-RADIOACTIVE | RADIOACTIVE | | ||||||||||||
| NATURE AND QUANTITY OF DANGEROUS GOODS | |||||||||||||
| Dangerous Goods Identification | Quantity and type of packing | Packing Inst | Authorization | ||||||||||
| Proper Shipping Name | Class or Division | UN or ID No | Packing Group | Subsidiary Risk | |||||||||
| Additional Handling Information | |||||||||||||
| I hereby declare that the contents or this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in the proper condition for transport by air according to the applicable international and national government regulations. | Name and Title of Signatory Place and Date Signature (see warning above) | ||||||||||||
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| . | . | . | ʳ | ϳ | ||||||
| , , , , | ʼ , ̳ ϳ | |||||||||
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