船舶载运危货物申报单GZ1W11.doc

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1、船舶载运危险货物申报单GZ1W11DeclarationFormForDangerousGoodsCarriedByShip（包装∕固体散装危险货物）(Packaged∕SolidinBulk)船名：航次：进港始发港：抵港时间：Ship’sName:VoyageNo.:ArrivalPortofDeparture:TimeofArrival:国籍：经营人：出港作业泊位：作业时间货物正确运输名称ProperShippingNameofTheGoods类别∕性质Class/Property危规编号UNNo.装运形式MeansofTransport件数NumberofPackages总

2、重量WeightinTotal卸货港PortofDischarging装载位置LocationofStowage备注Remarks兹声明根据船舶装载危险货物安全和防污染规定，本轮具备装载上述货物的适装条件，货物配装符合要求。申报内容准确无误。Iherebydeclarethat,inaccordancewiththeprovisionsofsafetransportationofdangerousgoodsbyshipsandpollution,thisshiphasmettherequirementsoffitnessforcarryingtheabovedeclaredgoo

3、ds;Cargostowageisproperlyplannedaccordingtotherequirements;thedocumentationofthecargoiscompleteandthecontentsofthedeclarationaretrueandcorrect.附送以下单证、资料Thefollowingdocumentsandinformationaresubmittedinaddition.轮船长/申报员：船舶/代理人（盖章）Master/Declarer:Ship/agent(seal)船长/申报员证书编号：日期：CertificateNo.:Date

4、:紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPerson’sName,Tel,FaxandE-mail:111Nationality:Manager:DepartureBerth:TimeofLoading:此申报单一式三份，其中两位退申报人留持并分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.中华人民共和国海事局监制