TO THE RECEIVING AUTHORITY
Please receive for shipment the goods described below subject to your published regulations and conditions (including those as to liability)

SPECIFY : PROPER SHIPPING NAME,IMO HAZARD CLASS, UN NO. Additional information (if applicable see next sheet)

CONTAINER/ VEHICLE
PACKING CERTIFICATE

I hereby declare that the goods
described above
have been
packed/loaded
into the container/
vehicle identified
below in
accordance with
the provision
shown overleaf:

MUST BE COMPLETED
AND SIGNED FOR ALL
CONTAINER/
VEHICLE LOADS
BY PERSON
RESPONSIBLE
FOR PACKING/
LOADING:

THIS IS TO CERTIFY AND CONFIRM THAT WE HAVE AFFIXED PROPERLY THE APPROPRIATE GOOD QUALITY IMCO CLASS STICKERS ON ALL FOUR SIDES OF THE CONTAINER

SIGNATURE OF DECLARANT

PROPER SHIPPING NAME - TRADE NAMES ALONE ARE UNACCEPTABLE

DANGEROUS GOODS DECLARATION

"I hereby declare that the contents of this consignment are fully and accurately decribed above by the correct technical name(s) (proper shipping name(s)), that the shipment is packaged in such a manner as to withstand the ordinary risks of handling and transport by sea, having regard to the properties of the goods to be carried, and that the goods are classified, packaged, marked and labelled in accordance with the requirements of the Merchant Shipping (Dangerous Goods and Marine Pollutant) Regulations 1990 as currently amended. I further declare that, if appropriate, the goods are classified, packaged and marked to comply with the requirements of the European Agreement concerning the International Carriage of Dangerous Goods by Road (ADR) and of Approx 1 (RID) to the Uniform Rules concerning the Contract for International Carriage of Goods by Rail (CIM) or special arrangements made between the contracting parties to these Agreements. The shipper must complete and sign box 17."

DOCK/TERMINAL RECEIPT Received the above number of packages/containers/trailers in apparent good order and condition unless stated hereon. RECEIVING AUTHORITY REMARKS