Multimodal Dangerous Goods Form

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DG Registration Number:

Contact Name:

Contact Telephone:

Attachment:

Disclaimer:

SHIPPER'S 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 in proper condition for transport according to the applicable international and national government regulations. CONTAINER PACKING CERTIFICATE
I hereby declare that the goods described above have been placed/loaded into the container/vehicle identified above in accordance with the applicable provisions. ** MUST BE COMPLETED AND SIGNED FOR ALL CONTAINER/VEHICLE LOADS BY PERSON RESPONSIBLE FOR PACKING/LOADING.