New Zealand Shipping Dangerous Good Declaration

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Please print out. Fill in details and fax back to Australia on ( 61+7 ) 3290 2481 or Fill in details and Submit
Pro-Forma | Commercial Invoice | Weight List | Packing Declaration | Beneficiary Certificate | Certificate of origin

1) Shipper	2) Reference number (s) e.g. bill of lading No.. customers reference No. or other

3) Consignee	4) Carrier

Container packing certificate/vehicle declaration DECLARATION It is declared that the packing of the container/vehicle has been carried out in accordance with the General introduction, IMDG Code, paragraph 12.3.7 or 17.7.7 TO BE COMPLETED FOR SHIPMENTS IN CONTAINERS OR VEHICLES	5) Packer name status (company/organization)
	Place and date
	Signature on behalf of packer _______________________

6) Vessel & voyage	7 ) Port of Loading	8) Port of Discharge

9) Additional Information

Marks & numbers	Number and kind of packages	Unit Quantity**	Gross Mass (kg)**	Cubic Vol. (m3)
NZ Ship - UN1133 Packing group 3.0 class3.1 - 40ctns - 156kgs - .936cbm

10) Goods delivered as:

Type of unit:

Proprietary/trade names alone are not sufficient. If applicable:(1) the word 'WASTE' should precede the name; (2) 'EMPTY UNCLEANED' or 'RESIDUE - LAST CONTAINED' should be added'; (3) 'LIMITED QUANTITY' should be added. * When required in 9.3 of the General introduction to the IMDG Code; *** When required
11) ADDITIONAL INFORMATION In certain circumstances special information/certificates are required, see IMDG Code, General Introduction, paragraphs 9.7.1/9.7.2. Any additional information should be entered in section 7 above, overleaf or attached to this form
DECLARATION I hereby declare that the contents of this consignment are fully and accurately described above by the correct technical name (s) ( proper shipping name (s), 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.
Yours faithfully

Signatory's Company:	______________________
12) *Name of authorised signatory (required)**
Place and date of issue
Signature for and on behalf of shipper	Email * (required) You are required to put in your name (authorised signatory) and email address, then click submit for your details to come back to us.