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SHIPPERS DECLARATION FOR DANGEROUS GOODS

Shipper

Air Waybill No. Page of Pages Shippers Reference Number (optional)

Consignee

Person Responsible for Shipment:

Four completed and signed copies of this Declaration must be handed to the operator.

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.

TRANSPORT DETAILS
This shipment is within the limitations prescribed for: (delete non-applicable)
PASSENGER AND CARGO AIRCRAFT CARGO AIRCRAFT ONLY

Airport of Departure

Airport of Destination

Shipment Type (delete non-applicable)


NON-RADIOACTIVE RADIOACTIVE

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods Identification UN or ID No. Proper Shipping Name Class or Division Packing (Subsidiary Group Risk) Quantity and Type of Packing Packing Instruc- Authorization tions

Additional Handling Information Emergency Telephone Number


I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labelled/placarded, and are in all respects in proper condition for transport according to the applicable international and national governmental regulations. I declare that all of the applicable air transport requirements have been met.

Name/Title of Signatory Place and Date Signature


(see warming above)

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