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IMO Declaration SHALOM

1) This dangerous goods declaration form meets the requirements of international regulations for transporting hazardous materials by sea and preventing marine pollution. 2) It provides information about the shipper, consignee, container details, description of items in the shipment including proper shipping name, UN number, hazards, and a declaration that the goods are properly packaged and labeled according to regulations. 3) The specific shipment contains lithium ion batteries in bulk packaging being shipped from Miami, FL to Panama City, Panama.
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0% found this document useful (0 votes)
644 views

IMO Declaration SHALOM

1) This dangerous goods declaration form meets the requirements of international regulations for transporting hazardous materials by sea and preventing marine pollution. 2) It provides information about the shipper, consignee, container details, description of items in the shipment including proper shipping name, UN number, hazards, and a declaration that the goods are properly packaged and labeled according to regulations. 3) The specific shipment contains lithium ion batteries in bulk packaging being shipped from Miami, FL to Panama City, Panama.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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IMO DANGEROUS GOODS DECLARATION

This form meets the requirement of SOLAS 74 chapter VII, regulation 5;


MARPOL 73/78 ANNEX III, regulation 4 and the IMDG CODE, General introduction, section 9

Shipper 1 Reference number(s) 2

SAND SPORTS CORP Page 1 of 1 INVOICES


1835 NW 112th AVE. Ste. 159
Miami, Fl 33172 Shipper's Reference Number 8260/8271
3 Carrier: 4
Consignee
SHALOM S.A
AV. CENTRAL ESPANA, PANAMA CITY KIOMEX LLC
PANAMA, ESTAION LOTERIA. PANAMA 8435 NW 72ST
MIAMI FLORIDA 33166

Container packing certificate/vehicle declaration Name/status, company/organization of signatory 5

DECLARATION
Place and date
It is declared that the packing of the container/vehicle has been carried
out in accordance with the General Introduction, IMDG Code, paragraph
5.4.2
Signature on behalf of packer
TO BE COMPLETED FOR SHIPMENTS IN CONTAINERS OR VEHICLES

Ship's name and voyage No. Port of loading 6 Instructions or other matter 7

Port of discharge 8

Marks Nos. Number and kind of packages, proper shipping name *, IMO hazard Gross mass 9
If applicable, class/division, UN number, packaging group (where assigned) * *, (kg,), net Goods
identification or flashpoint (in ºC.c.c.) * *, control and emergency temperatures * *, quantity/mass* * delivered as:
registration number(s) identification of the good as MARINE POLLUTANT* *, EmS No. and
of the Unit MFAG Table No.*** Breakbulk
cargo

Unitized
N/A UN3481 LITHIUM IO BATTERIES IN 300 LBS cargo
COMPLIANCE WITH SECTION II OF PI967
X Bulk
packages
CLASS 9 -
Type of unit (container,
Lithium ion batteries contained in equipment trailer, tank vehicle, etc.)

X Open

Closed

Insert "X" in
approriate box

(This column may be left


empty apart from the
* Synonyms should not be used. Proprietary/trade names alone are not sufficient. If applicable:(1) the word "WASTE" should precede the nam heading, in which case
(2) "EMPTY UNCLEANED" or "RESIDUE-LAST CONTAINED" should be added insert appropriate
(3) "LIMITED QUANTITY" should be added. description)

* * When required in paragraph 9.3 of the General Introduction to the IMDG code; * * * When required.
The IMDG Code page number should not appear on this form.
ADDITIONAL INFORMATION 10
(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.

Name/status, company/organization of signatory 11


DECLARATION
SandSports Corp
I hereby declare that the contents of this consignment are fully and accurately Place and Date
described above by the proper shipping name(s), and are classified, packaged,
marked and labeled/placarded, and are in all
04-18-2023
respects in proper condition for transport according to applicable
international and national governmental regulations. Signature on behalf of shipper

A.Alcala

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