GENERAL DECLARATION

OUTWARD/INWARD
Owner or Operator URAL AIRLINES

Marks of Nationaly and Registration Flight No U6862 Date 15.08.18

Departure from PEK Arrival at SVX

(Place) (Place)
BEIJING/PEKING - EKATERINBURG

FLIGHT ROUTING
international transportation of passengers, cargo and luggage
(Place. Column always to list origin, every en-route stop destination)
NUMBER OF PASSENGERS ON THIS
PLACE NAMES OF CREW
STATE
TOPOCHKANOV ALEKSANDR Departure Place: BEIJING/PEKING
UVAROV VADIM Embarking
SUSLOV SERGEI Trough on same flight
PEDOS ALLA
KARELINA OLGA
STAFEEVA KRISTINA Pax:_____________________________
IVANOV LEONID Bag:_____________________________
Cargo:____________________________
Mail:_____________________________

Arrival Place: EKATERINBURG

Disembarking
Trough on same flight

Declaration of Health For official use only

Name and seat number or funtion of persons on board with illenesses other than airsikness or
the effects of accident, who may be suffering from a communicable desiase (a fever -
temperature 38C/ 100F or greater -associated with one or more of the following sings or
symptoms, e.g. appearing obviously unwell; persistent coughing; impaired breating;
persistent diarrhoea; persistent vomiting; skin rash; bruising or bleeding without previous
injury; or confusions of recent onset, increases the likelihood than the person is suffering a
communicable disease) as well as such cases of illness disembarked during a previous
stop .............................................................................. ...........................................................
.....................................................................................
Detail of each disinsecting or sanitary treatment (place, date, time, method) during the flight.
If no disinsecting has been carried out during the flihgt give details of most recent
disinsecting …………………...........................................................………………................
….
…………………………………………………………………………………………………
……

Signed, if required, with time and date

Crew member concerned

I declare that all Statements and particulars contained in this General Declaration, and in any supplementery forms required to
be presented with this General Declaration ara complete, exact and true to be best of my knowledge and that all through
passengers will continue/have continued on the flight.

SIGNATURE ____________________________________
Autorized Agent or Pilot-in-Command
На борту воздушного судна отсутствуют:
– товары, ввоз (вывоз) которых запрещен или ограничен;
– лекарственные средства, в составе которых содержатся наркотические,
– сильнодействующие средства, психотропные и ядовитые вещества;
– оружие и боеприпасы./
/On the aircraft board the crew has no:
– goods which importation is prohibited or restricted;
– medicines consisting of narcotic, powerful remedies, psychotropic and
poisonous substance;
– weapon and ammunition;

КВС/captain TOPOCHKANOV ALEKSANDR

(подпись)/(signature) (фамилия, инициалы)/(surname) (дата)/(date).

Топливо/Fuel:

Остаток/the rest of fuel ________________________ кг/kg;

Заправлено/fuel loaded ________________________ кг/kg;

Общее количество total ________________________ кг/kg;

Обязуюсь на территории Российской Федерации топливо не выгружать/

/I undertake not to unload fuel on the territory of Russian Federation.

КВС/captain TOPOCHKANOV ALEKSANDR

(подпись)/(signature) (фамилия, инициалы)/(surname) (дата)/(date).

Таможенный пост Аэропорта

ГТИ ________________ ________________ ________________

(подпись) (фамилия, инициалы) (дата)/(date).