DOC《Shipper's Name & Address（托运人名称,地址）》

Shipper's Name & Address(托运人名称,地址) T.

S. LINES德翔航运 AGENT FOR T.S. SHIPPING AGENCY CO LTD DECLARATION OF DANGEROUS GOODS 危险货物申报书 DANGEROUS PACKING CERTIFICATE 危险货物包装证明书 Consignee's Name & Address(收货人名称,地址) Ship's Stowage Location (积载位置) Ocean Vessel Voy No. S/O No. Container No.(货柜号码) Place of receipt(收货地) Place of delivery(交货地) Ship's Operator(运送人) Container Operator(货柜管理人) Port of loading(装货港) Port of discharge(卸货港) Vanning Survey Req.Not Req. (装柜检查)要 不要 Marks & No.(麦头及号码) King of Packages ;

Description of Goods Number Proper Shipping Name(品名) Inner Receptacle / Weight Outer Package/Weight (内装/数量/重、容量) (内装/数量/重、容量) PACKING CODE: IMDG Class Total Weight (Gross/Net)(Kg/Kl) UN No. IMDG Page No. Marine Pollutant Yes No Label Flash-Point Packing Group Properties 危险货物性质 Appearance 外观 Odour 气味 Specific Gravity 比重 Ignition point 燃点 Toxicity (LD/TLV) 毒性质 Reactivity and/or Other Hazard 反应性及其它危险性 Emergency Procedures 灾害发生时之处理 Prevention Measures 防灾处理 Protection Equipments 防灾装备 Medical First Aid 医疗处理 Emergency Communication (紧急时联络) I hereby certify that 1. The container was clean, dry and apparently fit to receive goods. 2. No incompatible substances have been packed into the container. 3. All packages have been externally inspected for damage, leakage or sifting, and only sound packages have been loaded. 4. All packages have been property packed in the container and secured. 5. The container and packages are property marked and labelled. 6. When solid carbon dioxide (dry ice)is used for cooling purposes, the container is externally marked or labelled in a conspicious place at the door end, reading:"DANGEROUS CO2-GAS(DRY ICE) INSIDE. VENTILATE THOROUGHLY BEFORE ENTERING." 7. The dangerous goods declaration required in sub-section9.4 of the General Introduction to the International Maritime Dangerous Goods (IMDG) code has been received for each dangerous goods consignment packed in the container. 8. If the consignments include goods of class 1,expect division 1.4,The vehicle container is structurally serviceable in conformity with section

12 of the introduction to class

1 of the IMDG Code. 9. When dangerous goods are transported in bulk packagings,the cargo has been evenly distributed. I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked and labelled,and are in all respects in proper condition for transport by sea ,land according to applicable international and national governmental regulations. This is to certify that the above-named materials are properly classified, described, packaged, marked, and labelled, and are in proper condition for transportation according to the applicable regulation of the Department of Transportation. Signature of Shipper DATE: