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Multimodal

This multimodal dangerous goods form is used to declare dangerous goods being transported and meets the requirements of international regulations. It provides shipping information such as the shipper, transport document number, delivery address, emergency contact details, vessel/flight details, description of goods, packaging, container/vehicle identification, and certifications that the goods are properly packed and labeled according to applicable regulations. The form declares that the contents involving helium gas cylinders are accurately described and in proper condition for transport according to dangerous goods regulations.

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Suporte Comex
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594 views1 page

Multimodal

This multimodal dangerous goods form is used to declare dangerous goods being transported and meets the requirements of international regulations. It provides shipping information such as the shipper, transport document number, delivery address, emergency contact details, vessel/flight details, description of goods, packaging, container/vehicle identification, and certifications that the goods are properly packed and labeled according to applicable regulations. The form declares that the contents involving helium gas cylinders are accurately described and in proper condition for transport according to dangerous goods regulations.

Uploaded by

Suporte Comex
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MULTIMODAL DANGEROUS GOODS FORM

This form may be used as a dangerous goods declaration as it meets the requirements of SOLAS 74, chapter VII, regulation 5; MARPOL
73/78 Annex III, regulation 4
1Shipper/Consignor/Sender 2Transportdocumentnumber

Morlando Group srl 3Page 1 of 1 page 4Shipper'sreference


VIA FRANCESCO CRISPI,92
5Freightforwarder'sreference
80121-NAPOLI (NA)
7 Carrier (to be completed by the
carrier)

SHIPPER'S DECLARATION

I hereby declare that the contents of this consignment are fully and
DELIVERY ADDRESS
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.
8 This shipment is within the limitations prescribed for:
9Additionalhandling information
(Delete non-applicable)

PASSENGER AND CARGO Emergency response :


CARGO AIRCRAFT ONLY
AIRCRAFT Emergency call: 081-8335018
10 Vessel/flight No. and
date 11Port/place of loading
Naples
12Port/place of discharge 13Destination
BRAZIL
14 Shipping marks *Number and kind of packages; description of goods Gross mass (Kg) Net mass (Kg)
Cube (m3)

HELIUM GAS CYLINDERS


UN 1046 HELIUM COMPRESSED 2.2 (E)
EMS F-C,S-VB
QUANTITY/QUANTITA'NO1CYLINDERS
NO.144HELIUM 18PALLONCINI
NO.96HELIUM 35PALLONCINI

NETWEIGHT/PESO NETTO 2KGS.


GROSS WEIGHT/PESO LORDO 650KGS
PACKING INSTRUCTION(S) P200

15 Container 16Seal 17Container/vehiclesize 18Tare mass (Kg) 19 Total gross mass


identificationNo./ number(s) &type (including tare) (Kg)
vehicleregistration No.

CONTAINER/VEHICLE PACKING CERTIFICATE 21RECEIVING ORGANIZATION RECEIPT


I hereby declare that the goods described above have been packed/loaded Received the above number of packages/containers/trailers in apparent good
into the container/vehicle identified above in accordance whit the order and condition, unless stated hereon: RECEIVING ORGANIZATION
applicable provisions.+ REMARKS:
MUST BE COMPLETED AND SIGNED FOR ALL CONTAINER/VEHICLE
LOADS BY PERSON RESPONSIBLE FOR PACKING/LOADING
20Name of company Haulier'sname 22 Name of company (OF SHIPPER
PREPARING THIS NOTE)
Morlando Group Srl
Name /status of Name/status of
declarant Vehicle reg. no declarant

Place and
date Signature and Place and
date date
Casandrino (NA),- Casandrino (NA) -
Signature of Signature of
declarant DRIVER'S SIGNATURE declarant

* DANGEROUS GOODS:
You must specify: Proper Shipping Name, hazard class, UN No., packing group, (where assigned) marine pollutant and observe the mandatory
requirements under applicable national and international governmental regulations. For the purposes of IMDG Code see 5.4.1.1..
+ For the purposes of the IMDG Code, see 5.4.2..

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