1. Shipper:

6. Consignee:

2. Transport Document Number:

3. Page of Pages:

4. Shipper's Reference:

5. Freight Forwarder's Reference:

7. Carrier (to be declared by the carrier):

I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name(s), and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations.

10. Truck and Date:

11. Place Handling:

9. Additional Handling Information:

Shipping Marks	Number and kind of Packages, Description of Goods	GW (lbs./kg)	CUBE (m³)

13. CTU ID No.:

14. Seal No.:

15. CTU Size and Type:

16. Tare Mass (lbs./kg):

17. Total Weight (lbs./kg):

18. Container/Vehicle Packing Certificate

I hereby declare the goods described above have been packed/loaded into the container/vehicle identified above in accordance with the applicable provisions.

19. Receiving Organization Receipt

Received the above number of packages/containers/trailers in apparent good order and condition, unless stated hereon:

RECEIVING ORGANIZATION REMARKS:

IMO Declaration Form

18. Container/Vehicle Packing Certificate

19. Receiving Organization Receipt

IMO Declaration Preview