<p> IMO DANGEROUS GOODS DECLARATION This form meets the requirements of SOLAS’74 chapter VII, regulation 5:</p><p>MARPOL 73/78 Annex III, regulation 4 and the IMDG Code, General Introduction, section 9</p><p>Shipper Reference number(s)</p><p> s/o</p><p> booking no:</p><p>Consignee Carrier</p><p>Container packing certificate/vehicle declaration Name/status, company/organization of signatory</p><p>DECLARATION Place and date</p><p>It is declared that the packing of the container/vehicle has been carried out in Signature on behalf of packer accordance with the General Introduction. IMDG Code. Paragraph 12.3.7 or 17.7.7.</p><p>TO BE COMPLETED FOR SHIPMENTS IN CONTAINERS OR VEHICLES</p><p>Ship’s name and voyage No. Port of loading (Reserved for text, instructions or other matter)</p><p>Port of discharge</p><p>Marks & No. Number and kind of packages, proper shipping name*, IMO hazard Gross mass (kg), net Good delivered as</p><p>If applicable. Identification or class/division, UN Number, packaging group (where assigned)**, flashpoing quantity/mass** registration number(s) of the unit (in C c.c.)**, control and emergency temperatures**, identification of the □ Breakbulk cargo</p><p> goods as MARINE POLLUTANT**, EMS No. and MFAG table No.***</p><p>□ Unitized cargo</p><p>□ Bulk packages</p><p>Type of unit (container, trailer,</p><p> tank vehicle, etc.)</p><p>Container number: □ Open</p><p>□ Closed</p><p>Insert “X” in appropriate box</p><p>(This column may be left </p><p> empty apart from the heading, </p><p> in which case insert </p><p> appropriate description) ‘Synonyms should not be used. Proprietary/trade names alone are not sufficient. If applicable: (1) the word “WASTE” should precede the name: (2) “EMPTY </p><p>UNCLEANED” OR “RESIDUE – LAST CONTAINED” should be added; (3) “LIMITED QUANTITY” should be added. </p><p>** When required in 9.3 of the General Introduction to the IMDG Code.</p><p>*** When required</p><p>ADDITIONAL INFORMATION</p><p>In certain circumstances special information/certificates are required. See IMDG Code, General Introduction, paragraphs 9.7.1, 9.7.2, 9.9.1 and 9.10.1.</p><p>DECLARATION Name/status, company/organization of signatory</p><p>I hereby declare that the comtents of this consignment are fully and accurately described above by the proper shipping Place and date 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 Signature on behalf of shipper national governmental regulations.</p><p>IMDG CODE – PAGE 0039 Amdt. 27-94</p><p>CONTAINER PACKING CERTIFICATE Booking no: vessel&voyage:</p><p>Those responsible for the packing of dangerous goods into a container shall certify that this has been properly carried out and embodying the following provisions :</p><p>1) The container was clean, dry and apparently fit to receive goods.</p><p>2) No incompatible substances have been packed into the container.</p><p>3) All packages have been externally inspected for damage, and only sound packages packed.</p><p>4) All packages have been properly packed in the container and safely secured.</p><p>5) The container and packages are properly marked and labelled.</p><p>6) All packages packed according to IMCO.</p><p>7) 24 HOURS EMERGENCY CONTACT: Port of Loading: Port of discharge: Container number Contents of Packing Tons U. N. Packing IMCO Container Number group Class</p><p>We hereby certify that the abovementioned requirements are fulfilled.</p><p>Received onboard: Date:</p><p>Chief Officer Signature</p>