5962584513

SHIPPER'S DECLARATION FOR DANGEROUS GOODS

Shipper

Consignee

Air Waybill No.

Page of Pages Shipper^s Reference Number

(opdonal)

For optional use for

Company logo name and address

Two completed and signed copies of this Declaration must    WA R NIN G

be handed to the operator.    I

TRANSPORT DETA1LS

Airport of Departure:

Failure to compły in all respects with the applicabłe Dangerous Goods Regulations may be in breach of the applicabłe law. subject to legał penalties.

This shipment is within the limitations prescribed for: (delete non-applicabte)

PASSENGER	CARGO
AND CARGO	AIRCRAFT
AIRCRAFT	ONLY

Airport of Destination:

Shipment typo: (dototo non-appfcsbio) 1N0N.RAD|0ACT|VE 1 RAOjOACMO

NATURĘ ANO OUANTITY OF DANGEROUS GOODS Dangerous Goods Identification

UN ;		Class	Pack
Of id :	Proper Shipping Namo	; orDivision • (Subsidiary	ing Group
No.		Risk)

Ouantity and type of packing

Packing

Inst.

Authorization

Additionał Handling Information

Name/Title of Signatory Place and Datę Signature

fsoo warnog atxvo)

I hereby declare that the contents of this consignment are fully and accurately described above 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 applicabłe international and national governmental regulations. I declare that all of the applicablo air transport roguiromonts havo beon met.