(COMPANY LETTER HEAD)

DATE

We, NAME OF COMPANY, certify that the containers listed below are clean and empty. We deliver this certificate in order
to process to the loading of those containers as EMPTY

EMPTY CONTAINERS:

CONTAINER N# CONTAINER CONTAINER DESCRIPTION CONTAINER TARE

TYPE in KG

DTOU XXX XXX X 20’TK EMPTY CONTAINER (SOC) 3980

LBOU XXX XXX X 20’HT EMPTY CONTAINER (SOC) 3980

The above listed containers are verified empty and clean (ex content not dangerous).

Before returning an empty tank for shipment, kindly make sure that:

1) The tanks have been emptied

2) The valves have been closed

3) The safety plates (at the outlet of the valves) correctly put in place.

4) The traces of bitumen on the parishes of the tanks removed

We want these measures to be respected in order to avoid inconveniences that would be detrimental to us all.

In the event of product spillage/leakage, when transporting empty containers, please note that all costs related
to cleanings, decontaminations and modifications by the various authorities will be charged to you.

In witness whereof, the present attestation is delivered for the end of and purpose for which it is designed.

Signatory name

Signature and stamped