危险货物安全适运申报单.doc

MI07-022-03危险货物安全适运申报单DeclarationonSafetyandFitnessofDangerousGoods(包装/固体散装危险货物)(Packaged/SolidinBulk)发货人:Shipper:收货人:Consignee:承运人:Carrier:船名和航次:Ship’sNameandVoyageNo.:装货港:PortofLoading:卸货港:PortofDischarging:货物标记和编号,如适用,组件的识另符号或登记号Marks&Nos,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**、应急措施编号和医疗急救指南表号***Propershippingname*,IMOhazardclass/division,UNnumber,packaginggroup**,numberandkindofpackages,flashpoint(℃.),controlandEmergencytemperature**,identificationofthegoodsasMARINEPOLLUTANT**,.***总重(Kg)净重/净量Totalweight(weight(kg)交付装运货物的形式:Goodsdeliveredas:□杂货Breakbulkcargo□成组件Unitizedcargo□散货包装Bulkpackages□散装固体Solidinbulk□组件类型Typeofunit:□集装箱Container□车辆Vehicle□罐柜Portabletank□开敞式Open□封闭式Close如适合,在方格内划“×”Insert“×”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)“空的未经清洁的”或“含有残余物—上一次盛装物”;(3)“限量”**如需要,见《国际危规》第Ⅰ***需要时“Proprietary/:(1)theword“WASTE”shoudproceedthename;(2)“EMPTY/UNCLEANED”or“RESIDUE-LASTCONTAINED”;(3)“LIMITEDQUANTITY”shoudbeadded.**,Volume1oftheIMDGCode***WhenREquired附送以下单证、资料:Thefollowingdocument(s)andinformationaresubmitted:在某种情况下,需提供特殊资料证书,详见《国际危规》第Ⅰ。Incertaincircumstancesspecialinformationcertificatesarerequired,,volume1ofIMDGCode兹声明:上述拟交付船舶装运的危险货物已按规定全部并准