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1、危险货物/污染危害性货物安全适运申报单DeclarationonSafetyandFitnessofDangerousGoods/HazardousGoods(包装货物)(Packaged)进港Arrival□/出港Departure□发货人:Shipper:收货人:Consignee:承运人Carrier船名和航次:Ship’sname&VoyageNO.:装卸港:PortofLoading:卸货港:PortofDischarging:货物标记和编号,如适用,组件的识别符号或登记号:Marks&N
2、os,oftheGoods,ifapplicable,identificationorregistrationnumber(s)Oftheunit正确运输名称*、危险类别、危规编号;包装类**、包件的种类和数量、闪点℃(闪杯)**、控制及应急温度**、货物为海洋污染物**、应急措施编号***Propershippingname*,IMOhazardclass/division,UNnumber,packaginggroup**,numberandkindofpackages,flashpoint(℃
3、c.c.),controlandemergencytemperature**,identificationofthegoodsasMARINEPOLLUTANT**,EmsNo.***总重(kg)净重/净量Totalweight(kg)Netweight(kg)交付装运货物的形式:Goodsdelivedas:□杂货Breakbulkcargo□成组件Unitizedcargobox□散货包装Bulkpackages□散装固体Solidinbulk组件类型:Typeofunit:□集装箱Contai
4、ner□车辆Vehicle□罐柜Portabletank□开敞式Open□封闭式Close如适合,在方框内划“×”Inset“×”inappropriatebox*仅使用专利商标/商品名称是不够的,如适合:(1)应在品名前加“废弃物”;(2)“空的未经清洁含有残余物-上一次盛装物”;(3)“限量”**如需要,见《国际危规》第2卷第3.4.6款***需要时*Proprietary/tradenamesalonearenotsufficient.Ifapplicable:(1)theworld“WAST
5、E”shouldproceedname;(2)”EMPTY/UNCLEANED”or“RESIDUE-LASTCONTAINED”;(3)”LIMITEDQUANTITY”theshouldbeadded.**Whenrequiredinitem3.4.6,volume2oftheIMDGCode;***Whenrequired附送以下单证、资料:Thefollowingdocuments(s)andinformationaresubmitted:在某种情况下,需提供特殊资料证书,详见《国际危规》第
6、1卷第5.4.4节。Incertaincircumstancesspecialinformationcertificatesarerequired,seeparagraph5.4.4,volume1ofIMDGCode.兹声明:上述拟交付船舶装运的危险货物/污染危害性货物已按规定全部并准确地填写了正确运输名称、危规编号、分类、危险性和应急措施,需附单证齐全。包装危险货物,包装正确、质量完好;标记、标志/标牌正确、耐久。以上申报准确无误。Declaration:Iherebydeclarethatth
7、econtentsofthisdeclarationarefullyandaccuratelydescribedabovebythepropershippingname,UNNo.,ClassandEmSNo.Thegoodsareproperlypackaged,marked,labeled/placardedandareinallrespectsingoodconditionfortransportbysea.申报人员姓名:申报单位签章Declarer(signature):SealofDecl
8、arationUnit申报人员培训备案编号:年月日No.:YearMonthDate主管机关签注栏:RemarksbytheAdministration:紧急联系人姓名、电话、传真、电子邮箱:EmergencyContactPerson’sName,Tel,FaxandE-mail:此申报单一式三份,其中两份申报人留持和分送承运船舶,一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdmi