IMO FORM IC222E-2003 Multimodal Dangerous Goods Form.pdf

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1、MULTIMODAL DANGEROUS GOODS FORM 3 Page 1 of pages ShiPPer/Consignor/Sender 4 Shippers reference 5 Freight forwarders reference i Consignee 2 Port/Place of discharge I This shipment is within the limitations prescribed for: (delete non-applicable) PASSENGER AND I CARGO AIRCRAFT CARGO AIRCRAFT ONLY 13

2、 Destination O Vessel/Flight number and date 11 Port/Place of loading SHIPPERS DECLARATION I hereby declare that the contents of this consignment are fully and accurately described below by the proper shipping name, and are classified, packaged, marked and labelled/placarded and are in all respects

3、in proper condition for transport according to the applicable international and national governmental regulatlons. 9 Additional handling information Vehicle registration number :ONTAINER/VEHICLE PACKING CERTIFICATE hereby declare that the goods described above have been iacked/loaded into the contai

4、ner/vehicle identified above n accordance with the applicable provisions.* JIUST BE COMPLETED AND SIGNED FOR ALL :ONTAINER/VEHICLE LOADS BY PERSON 3ESPONSIBLE FOR PACKING/LOADING O Name of company IamelStatus of declarant lace and date #ignature of declarant IANGEROUS GOODS: You must specify proper

5、shipping name, hazard class, UN N rernmental regulations. For the purposes of the IMDG Code see 5.4.1.4. * For I17 Container/Vehicle size and type 18 Tare mass (kg) 19 Total gross mass I (including tare) I (kg) I I I !1 RECEIVING ORGANIZATION RECEIPT leceived the above number of packages/containers/

6、trailers in apparent good order and condition, tnless stated hereon: RECEIVING ORGANIZATION REMARKS: iauliers name ehicle reg. number iignature and date Place and date )RIVERS SIGNATURE Signature of declarant I icking group. (where assigned) Marine Pollutant and observe the mandatory requirements un

7、der applicable national and international Iurposes of the IMDG Code see 5.4.2 Container/Vehicle Packing Certificate The signature given overleaf in Box 20 must be that of the person controlling the container/vehicle operation. It is certified that: The container/vehicle was clean, dry and apparently

8、 fit to receive the goods If the consignments include goods of Class 1, other than division 1.4, the container is structurally serviceable. No incompatible goods have been packed into the container/vehicle unless specially authorized by the Competent Authority. All packages have been externally insp

9、ected for damage and only sound packages packed. Drums have been stowed in an upright position, unless otherwise authorized by the Competent Authority. All packages have been properly packed and secured in the container/vehicle When materials are transported in bulk packagings, the cargo has been ev

10、enly distributed in the container/vehicle. The packages and the container/vehicle have been properly marked, labelled and placarded. Any irrelevant marks, labels and placards have been removed. When solid carbon dioxide (CO2 - dry ice) is used for cooling purposes, the vehicle or freight container i

11、s externally marked or labelled in a conspicuous place, e.g. at the door end, with the words: DANGEROUS CO2 GAS (DRY ICE) INSIDE - VENTILATE THOROUGHLY BEFORE ENTERING. When this Dangerous Goods Form is used as a container/vehicle packing certificate only, not a combined document, a dangerous goods declaration signed by the shipper or supplier must have been issued/received to cover each dangerous goods consignment packed in the container. Note: The container packing certificate is not required for tanks.