Certificate of Condition for Transport of

Vehicles, Machines or Equipment

Shipper
Company:
Address:
City & Province:
Country:
Postal Code:
Contact name: Tel:
Email:
Consignee
Company:
Address:
City & Province:
Country:
Postal Code:
Attention:
Tel:

Please fill in details and check appropriate boxeson BOTH pages and email to:

1

Certificate of Condition for Transport of

Vehicles, Machines or Equipment

  1. Mode of Transport -☐ Air☐ Marine
  1. The Consignment - I certify that this consignment consists of (please indicate number of items):

Vehicle(s) : / Machine(s)/Equipment(s) specify) :
☐(_____) Automobile(s)
☐(_____) Powerboat(s)
☐(_____) Motorcycle(s)
☐(_____) Powerboat(s)
☐(_____) Other(s) (specify)
/ ☐(_____) Generator(s)
☐(_____) Chainsaw(s)
☐(_____) Lawnmower(s)
☐(_____) Outboard Motor(s)
☐(_____) Other(s) (specify)

Engine(s) Only : ( ______) (specify)

  1. Flammability - I certify that the above consignment is (are):

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Certificate of Condition for Transport of

Vehicles, Machines or Equipment

☐Flammable LIQUID Powered

☐ Flammable PROPANE Powered

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Certificate of Condition for Transport of

Vehicles, Machines or Equipment

  1. Battery - I certify that the above consignment either

☐Has NO batteryor

☐Has a battery and the battery terminals have been disconnected and the terminals taped to prevent short circuitsduring transport

  1. Alarm - I certify that theft-protection devices, installed radio communications equipment and/or navigational systems have/has been disabled.
  1. Fuel - I certify that the gas tank(s)

☐Is (are) drained of fuel as far as practicable and if any fuel remains it does NOT exceed ¼ of the tank capacity;

any disconnected fluid lines have been sealed with leak-proof caps.

  1. Packaging and NET Weight - The consignment is being offered for transport in the following packaging:
    Please indicate number of each packaging and NET Weightof engine(s)/vehicle(s) etc. in each.

☐(_____) As is, fully visible
☐(_____) In a cardboard box(es)
☐(_____) On a pallet(s) with cardboard covering
☐(_____) In a wooden box(es)
☐(_____) In a slatted wooden crate(s)
☐(_____) Strapped down on pallet(s)
☐(_____) Shrink-Wrapped on a pallet (s)
☐(_____) Other(s)
  1. If a Freight Forwarder is being used,


Contact Name: Telephone #:

  1. I, certify that the above information is correct.

(Print name)

(Signature) (Date)

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Certificate of Condition for Transport of

Vehicles, Machines or Equipment

Billing Information:

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Certificate of Condition for Transport of

Vehicles, Machines or Equipment

☐ I have an account with Upward Packaging, P.O. #: or

☐I would like to pay with Credit Card:

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Certificate of Condition for Transport of

Vehicles, Machines or Equipment

☐Visa #:
Expiry:

☐Mastercard #:

Expiry:

1