Form No: DG01 - SHIPPER’S DECLARATION FOR DANGEROUS GOODS

Shipper / Consignee
TRANSPORT DETAILS / WARNING
Failure to comply in all respects with the applicable Dangerous Goods Regulations may be in breach of the applicable law, subject to legal penalties. This declaration must not, in any circumstances, be completed and/or signed by a consolidator, a forwarder or an IATA cargo agent.
This shipment is within the limitation prescribed for:
(delete non-applicable)
PASSENGER AND CARGO AIRCRAFT / CARGO AIRCRAFT ONLY
/ Airport of departure
Airport of destination / Shipment type: (delete non-applicable)
NON-RADIOACTIVE / RADIOACTIVE
NATURE AND QUANTITY OF DANGEROUS GOODS
Dangerous Goods Identification / Quantity and type
of packing / Packing
Inst. / Authorisation
Proper Shipping Name / Class
or
Divi-sion / UN
or
ID
No. / Pack-ing
Group / Subsi-diary
Risk
Additional Handling Information
I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labelled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. / Name/title of signatory
Place and date
Signature (see warning above)

FOR FIGAS USE

THE DANGEROUS GOODS OFFICER WILL CONSULT THE CURRENT IATA DANGEROUS GOODS REGULATIONS TO CONFIRM OR EXPAND THE INFORMATION PROVIDED, AND TO PREPARE NOTIFICATION TO THE CAPTAIN AS APPROPRIATE.

THESE DANGEROUS GOODS ARE PROHIBITED FOR CARRIAGE BY AIR

THESE DANGEROUS GOODS ARE PERMITTED FOR CARRIAGE BY AIR

THESE DANGEROUS GOODS ARE PERMITTED FOR CARRIAGE BY AIR SUBJECT TO WRITTEN EXEMPTION FROM THE DIRECTOR OF CIVIL AVIATION

THE DIRECTOR OF CIVIL AVIATION HAS EXEMPTED FIGAS TO CARRY THE DANGEROUS GOODS AS REQUESTED. EXEMPTION ATTACHED.
NAME ……………………………….. SIGNATURE ………………….. DATE …………
THE COMMANDER OF FLIGHT NO ……………… IS INFORMED OF THESE DANGEROUS GOODS CONSIGNED TO BE CARRIED IN THE FOLLOWING MANNER:



NAME ……………………………….. SIGNATURE ………………….. DATE …………
Accepted by CSO, FIGAS
Checked by FIGAS, Dangerous Goods Officer
Date: ……………………………… Signed: ………………………………

Dangerous Goods Checklist

Date of check:

Yes No N/A

1. Full name and address of shipper
2. Full name and address of consignee
3. Description of goods to be shipped
4. Dangerous Goods Officer authorised and signed for
5. Loading crew of aircraft been informed of Dangerous Goods
within freight to be loaded
6. All relevant labels been attached ie Flammable/Corrosive

PACKAGING QUALITY ACCEPTANCE CHECK LIST COMPLETED.

NAME ……………………………….. SIGNATURE ………………….. DATE …………

COMMANDERS ACCEPTANCE (IF REFUSED STATE REASON)
NAME ………………………. SIGNATURE ……….…………. DATE ………..………