Shipper (name and address)

发货人(名称/地址)

Reference number(s)/Booking number(s)

装箱单号/订舱单号

(Reserved for text, instruction or other matter

24-hour contact tel no. & person English speaking)

24 小时紧急联系人/电话 (具英文听说能力者)

Name of carrier(or his agent)

Gross weight (including outer packing)

毛重

Name/means of transport

运输工具名称/方式

BY SEA

Port/place of departure

装货港

Net Weight/NEC

净重/净质量

Port /place of destination

目的港

Marks & numbers: numbers & kind of packages: description of goods

INDICATE: 1.PROPER SHIPPING NAME   正确运输名称

*TECHNICAL NAME  (when required) 技术名称

HYDROGEN PEROXIDE

2.IMO CLASS/PACKING GROUP /UN NO.危品分类/包装类别/联合国编号

IMO CLASS:5.1 / II / UN NO.:2014

3. FLASHPOINT/BOILING POINT (when required) (in C)闪点/沸点

NO

4. MARINE POLLUTANT (when required)海洋污染

NO

Additional information

Special information is required for (1) goods of class 1. (2) gases (class 2). (3) certain flammable solids (class 4.1),

(4) certain organic peroxides (class 5.2) (5)infections substances (class 5.2) and (6) radioactive materials

(class 7). In certain circumstances (7) a container packing certificate (8) a vehicle declaration (9) a weathering certificate

or (10) a certificate exampling a substance, material or article from the provisions of the IMDG code is required

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 labeled. And are in all respect in proper condition or transport by  (import mode(s) of transport involved) according to the international government regulations.

Name/status of signatory

Place and date

Signature on behalf of shipper