DG Form CPC

MULTIMODAL DANGEROUS GOODS FORM
1 Shipper/Consignor/Sender 2 Transport document number (e.g.: Booking No. or B/L No.)
3 Page 1 of pages 4 Shipper’s reference
5 Freight forwarder’s reference
24 hour contact number: -NOT PROVIDED BY SHIPPER
Attn : -NOT PROVIDED BY SHIPPER
6 Consignee 7 Carrier (to be completed by the carrier)
SHIPPER’S DECLARATION
I hereby declare that the contents of this consignment are fully and accurately
described below 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 the applicable international and national governmental regulations.
I undertake to hold the Carrier fully harmless and indemnify them against any and
24 hour contact number:
all losses, damage, and expenses resulting from the failure to comply with the
Attn:
above.
6-1 Notify party’s
8 This shipment is within the limitations prescribed for： 9 Additional handling information:
Ems:
10.Vessel / flight No. and data 11 Port / place of loading US DOT ERG No.:
24 hr contact phone/person:
Others:(any special attention for transport: prepare by shipper)
ETA :
12 Port / place of discharge 13 Destination
14 Description of goods
UN number PROPER SHIPPING NAME (Technical IMO/CFR Packing Number and kind of packages Other description
name) class Group Gross mass (kg) (Flash Point, Limit Quantity, Marine
Subsidiary Net mass (kg) Pollutant, Special stowage requirement, etc.)
hazard(s) Cube (m )
3
15 Container identification 16 Seal number(s) 17 Container/vehicle 18 Tare mass (kg) 19 Total gross mass
No./vehicle registration No. size and type (including tare) (kg)
18-1 Total cargo mass (kg
FORM NO. OPDADS-E-001-00

CONTAINER/VEHICLE PACKING CERTIFICATE 21 RECEIVING ORGANISATION RECEIPT
I hereby declare that the goods described above have been Received the above number of packages/containers/trailers in apparent good order and
packed/loaded into the container/vehicle identified above in accordance condition, unless stated hereon:
with the applicable provisions. ♀ RECEIVING ORGANISATION REMARKS:
MUST BE COMPLETED AND SIGNED FOR ALL
CONTAINER/VEHICLE LOADS BY PERSON RESPONSIBLE
FOR PACKING/LOADING
20 Name of company Haulier’s name 22 Name of company (OF SHIPPER PREPARING THIS NOTE)
Name / status of declarant Vehicle registration No. Name/status of declarant
Place and data Signature and date Place and date
Signature of declarant DRIVER’S Signature of declarant
SIGNATURE
* DANGEROUS GOODS:
You must specify: UN No., proper shipping name, hazard class, packing group (where assigned), marine pollutant and observe the mandatory
requirements under applicable national and international governmental regulations. For the purposes of the IMDG Code, see 5.4.1.4
♀ For the purposes of the IMDG CODE, see 5.4.2.
Documentary Aspects of the International Transport of Dangerous Goods
Container/Vehicle Packing Certificate
The signature given overleaf in box 20 must be that of the person controlling the container/vehicle operation.
It is certified that:
1. The container/vehicle was clean, dry and apparently fit to receive the goods.
2. If the consignments include goods of class 1, other than division 1.4, the container/vehicle is structurally
serviceable.
3. No incompatible goods have been packed into the container/vehicle unless specially authorized by the competent
authority.
4. All packages have been externally inspected for damage and only sound packages packed.
5. Drums have been stowed in an upright position unless otherwise authorized by the competent authority.
6. All packages have been properly packed and secured in the container/vehicle.
7. When materials are transported in bulk packagings, the cargo has been evenly distributed in the container/vehicle.
8. The packages and the container/vehicle have been properly marked, labelled and placarded. Any irrelevant mark,
labels and placards have been removed.
9. When substances presenting a risk of asphyxiation are used for cooling or conditioning purposes (such as dry ice
(UN 1845) or nitrogen, refrigerated liquid (UN 1977) or argon, refrigerated liquid (UN 1951)), the
container/vehicle is externally marked in accordance with 5.5.3.6.
10. When this Dangerous Goods Form is used as a container/vehicle packing certificate only, not a combined
document, a dangerous goods Declaration signed by the shipper or supplier must have been issued/received to

cover each dangerous goods consignment packed in the container/vehicle.
Note: The container/vehicle packing certificate is not required for tanks.

DG Form CPC

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MULTIMODAL DANGEROUS GOODS FORM

1 Shipper/Consignor/Sender 2 Transport document number (e.g.: Booking No. or B/L No.)

3 Page 1 of pages 4 Shipper’s reference

5 Freight forwarder’s reference

24 hour contact number: -NOT PROVIDED BY SHIPPER

Attn : -NOT PROVIDED BY SHIPPER

6 Consignee 7 Carrier (to be completed by the carrier)

12 Port / place of discharge 13 Destination

Subsidiary Net mass (kg) Pollutant, Special stowage requirement, etc.)

No./vehicle registration No. size and type (including tare) (kg)

18-1 Total cargo mass (kg

FORM NO. OPDADS-E-001-00

with the applicable provisions. ♀ RECEIVING ORGANISATION REMARKS:

MUST BE COMPLETED AND SIGNED FOR ALL

CONTAINER/VEHICLE LOADS BY PERSON RESPONSIBLE

Name / status of declarant Vehicle registration No. Name/status of declarant

Place and data Signature and date Place and date

Signature of declarant DRIVER’S Signature of declarant

FORM NO. OPDADS-E-001-00

Note: The container/vehicle packing certificate is not required for tanks.

FORM NO. OPDADS-E-001-00

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