SHIPPER'S DECLARATION FOR DANGEROUS GOODS Show Fields

Shipper Air Waybill No.

Page of Pages

Shipper's Reference Number

(optional):

Consignee

Two completed and signed copies of this Declaration must WARNING

be handed to the operator.
Failure to comply in all respects with the applicable
TRANSPORT DETAILS
Dangerous Goods Regulations may be in breach of the
This shipment is within the Airport of Departure applicable law, subject to legal penalties. This Declaration
limitations prescribed for: must not, in any circumstances, be completed and/or
(delete non-applicable) signed by a consolidator, a forwarder or an IATA cargo
PASSENGER CARGO agent.
AND CARGO AIRCRAFT
AIRCRAFT ONLY
Shipment type: (delete non-applicable)
Airport of Destination: NON-RADIOACTIVE RADIOACTIVE

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods Identification

Quantity and Packing
Class UN Authorization
Pack- Subsi- type of packing Inst.
or or
Proper Shipping Name ing diary
Divi- ID
group Risk
sion No.

Additional Handling Information

24 hr. Emergency Contact Tel. No.: shipment is made under the provisions of ICAO

I hereby declare that the contents of this consignment are fully and Name/Title of Signatory
accurately described above by the proper shipping name, and are
classified, packaged, marked and labelled/placarded, and are in all Place and Date
respects in proper condition for transport according to applicable
international and national governmental regulations.
Signature
(see warning above)

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