DG APPLICATION DECLARATION FORM

Carrier: ECU-WORLDWIDE (SINGAPORE) PTE. LTD.

*Yellow Box - Manually fill in.

*Blue Box - Select from drop-down list.

Shipper (Booking Party) Company

Name:
Shipper (Booking Party) PIC:
HBL Number:
Customer Reference:

Export Vessel & Voyage: LEX/SIN/0021976/09/19

Port of Loading (POL): JAKARTA, INDONESIA
Port of Discharge (POD): SINGAPORE
Final Destination: SINGAPORE

Proper Shipping Name (PSN): LITHIUM ION BATTERIES

Chemical / Technical Name: -

UN Number: UN 3480
IMO Classification: 9 ← Select from drop-down list.
Subsidary Risk Label (if Any): ← Select from drop-down list.
Packing Group: - ← Select from drop-down list.
Flash Point (if Any): - Deg 'C c.c.
Quantity of OUTER Packaging: 3
OUTER Packaging Code: 4G ← Please Select from drop-down list.
Outer Others (Please Specify):
Quantity of INNER Packaging: 3
INNER Packaging Code: Others ← Please Select from drop-down list.
InnerOthers (Please Specify): METAL BOX
Gross Weight: KG
Nett Weight: KG
EMS Code: F-A, S-I
Marine Pollutant: NO ← Select from drop-down list.
States of Matter: SOLID ← Select from drop-down list.
Limited Quantity: NO ← Select from drop-down list.
Segregation Group (if Any):
24 hours Emergency Contact & PIC:

DECLARATION (Required For All Dangerous Goods) : I, hereby declare that the contents of above shipments are completed fully and accurately described and are in all
respect in proper condition for transport according to applicable and international and national governmental regulations.
• For Battery shipments, ensure goods are brand new and not related to Samung / Vivo.
• All commodities must NOT consist of Carbon Black, Clove or Magnet.

Date: 11-Jan-2023

Company Stamp & Signature:

PACKING GROUP: Codes for Types of Cargo, Packages and Packag
- Code Material
I
II 1A1 A
III 1A2 A
1B1 B
IMO: 1B2 B
2 1D D
2.1 1G G
2.2 1H1 H
2.3 1H2 H
3 2C1 C
4.1 2C2 C
4.2 3A1 A
4.3 3A2 A
5.1 3H1 H
5.2 3H2 H
6.1 4A A
6.2 4B B
8 4C1 C
9 4C2 C
4D D
MP & LTY QTY: 4F F
YES 4G G
NO 4H1 H
4H2 H
STATES: 5H1 H
SOLID 5H2 H
LIQUID 5H3 H
GAS 5H4 H
5L1 L
5L2 L
5L3 L
5M1 M
5M2 M
6HA1 H

6HA2 H

6HB H

6HB2 H

6HC H

6HD1 H
6HD2 H

6HG1 H

6HG2 H

6HH1 H

6HH2 H

6PA1 P

6PA2 P

6PB1 P

6PB2 P

6PC P

6PD1 P

6PD2 P

6PG1 P

6PG2 P

6PH1 P

6PH2 P

Others
Codes for Types of Cargo, Packages and Packaging Materials for Hazardous Cargo
Material Kind Category

Steel 1 Drums non-removable head

Steel 1 Drums removable head
Aluminium 1 Drums non-removable head
Aluminium 1 Drums removable head
Plywood 1 Drums
Fibre 1 Drums
Plastics 1 Drums non-removable head
Plastics 1 Drums removable head
Wooden 2 Barrels bung type
Wooden 2 Barrels removable head
Steel 3 Jerricans non-removable head
Steel 3 Jerricans removable head
Plastics 3 Jerricans non-removable head
Plastics 3 Jerricans removable head
Steel 4 Boxes
Aluminium 4 Boxes
Natural wood 4 Boxes ordinary
Natural wood 4 Boxes with sift-proof walls
Plywood 4 Boxes
Reconstituted wood 4 Boxes
Fibreboard 4 Boxes
Plastics 4 Boxes expanded
Plastics 4 Boxes solid
Woven plastics 5 Bags without inner lining or coating
Woven plastics 5 Bags silt-proof
Woven plastics 5 Bags water resistant
Plastics film 5 Bags
Textile 5 Bags without inner lining or coating
Textile 5 Bags sift-proof
Textile 5 Bags water resistant
Paper 5 Bags multiwall
Paper 5 Bags multiwall, water resistant
Plastics receptacle 6 Composite Packaging in steel drum

Plastics receptacle 6 Composite Packaging in steel crate or box

Plastics receptacle 6 Composite Packaging in aluminium drum

Plastics receptacle 6 Composite Packaging in aluminium crate or box

Plastics receptacle 6 Composite Packaging wooden box

Plastics receptacle 6 Composite Packaging in plywood drum

Plastics receptacle 6 Composite Packaging in plywood box

Plastics receptacle 6 Composite Packaging in fibre drum

Plastics receptacle 6 Composite Packaging in fibreboard box

Plastics receptacle 6 Composite Packaging in plastics drum

Plastics receptacle 6 Composite Packaging in solid plastics box

Glass, porcelain or stoneware receptacle 6 Composite Packaging in steel drum

Glass, porcelain or stoneware receptacle 6 Composite Packaging in steel crate or box

Glass, porcelain or stoneware receptacle 6 Composite Packaging in aluminium drum

Glass, porcelain or stoneware receptacle 6 Composite Packaging in aluminium crate or box

Glass, porcelain or stoneware receptacle 6 Composite Packaging wooden box

Glass, porcelain or stoneware receptacle 6 Composite Packaging in plywood drum

Glass, porcelain or stoneware receptacle 6 Composite Packaging in wickerwork hamper

Glass, porcelain or stoneware receptacle 6 Composite Packaging in fibre drum

Glass, porcelain or stoneware receptacle 6 Composite Packaging in fibreboard box

Glass, porcelain or stoneware receptacle 6 Composite Packaging in expanded plastics packagings

Glass, porcelain or stoneware receptacle 6 Composite Packaging in solid plastics packaging