DG Sample Manifest

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SHIPPER'S DECLARATION FOR DANGEROUS GOODS

Shipper
Chong Swee Chin CONSIGNMENT NO.
EPK-M01 M1 COMPLEX Page 1 of 1 Pages
Shipper's Reference Number
(optional)
CONSIGNED TO: OPERATOR:
Sukhpal S Singh MHS AVIATION SDN BHD
HSE-ERF
SM-EP
Two completed and signed copies of this Declaration must WARNING
be handed to the operator.
TRANSPORT DETAILS Failure to comply in all respects with the applicable
This shipment is within the Airport of Departure Dangerous Goods Regulations may be in breach of
limitations prescribed for: M1 COMPLEX the applicable law, subject to legal penalties. This
(delete non-applicable) declaration must not, in any circumstances, be
PASSENGER CARGO completed and/or signed by a consolidator, a
AND CARGO AIRCRAFT forwarder or an IATA cargo agent.
AIRCRAFT ONLY

Shipment type: (delete non-applicable)


DESTINATION: MIRI NON-RADIOACTIVE RADIOACTIVE
NATURE AND QUANTITY OF DANGEROUS GOODS (see sub-Section 8.1 of IATA Dangerous Goods Regulations)
Dangerous Goods Identification

Class UN Pack- Subsi- Packing Authorization


Proper Shipping Name or or ing diary Quantity and Inst
Divi- ID Group Risk type of packing
sion No.

Petroleum product 3 1268 II - 4 Bottles X 0.5 LITRES Y305


N.O.S IN WOODEN BOX

DIMENSION: 12" X 9" X 6"

Additional Handling Information

KEEP WOODEN BOX IN UPRIGHT POSITION

I hereby declare that the contents of this consignment are fully and Name/Title of Signatory
accurately described above by proper shipping name and are classified, Richard Holt Site Team Leader
packed, marked and labelled, and are in all respects in the proper Place and Date
condition for transport by air according to the applicable International and M1 Complex 06/06/2002
National Government Regulations. Signature
(see warning above)
ization

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