(2.10)--危险货物安全适运载运申报单.pdf

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1、危险货物安全适运申报单危险货物安全适运申报单 Declaration on Safety and Fitness of Dangerous Goods(包装/固体散装危险货物)(Packaged/Solid in Bulk)发货人：Shipper：收货人:Consignee:承运人:Carrier:船名和航次:Ships Name and Voyage:装货港:Port of Loading：卸货港：Port of Discharging：货物标记和编号，如 正确运输名称*、危险类别、危规编号、包装类*、适用，组件的识别符 包件的种类和数量、闪点(闭杯)*、控制及应急温度*、总重（kg）号或登

2、记号 货物为海洋污染物*、应急措施编号和医疗应急指南表号*净重/净量 Marks&Nos，of the Proper Shipping Name*、IMO hazard class/division、Total weight（kg）goods，if applicable，UN No.、Packaging group*、Number and kind of packages、Net weight（kg）identification or Flash Point(c.c)、Control and emeragency temperature*、registration number(s)of Id

3、entification of the goods as MARINE POLLUTANT*、the unit Ems NO.and MFAG Tanle NO.*仅使用专利商标/商品名称是不够的，如适合：(1)应在品名钱加“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 1 卷第 5.4.1.1 款*需要时*Proprietary/trade names alone are not sufficient.If applicable：(1)the word“WASTE”should proceed the name;(2)“EMPTY/UN

4、CLEANED”or“RESIDUE-LAST CONTAINED”;(3)“LIMITED QUANTITY”should be added.*When required in item 5.4.1.1,volume 1 of the IMDG Code;*When required.交付装运货物的形式：Goods delivered as：杂货 Break bulk carg 成组件 Unitized cargo 散货包装 Bulk Packages 散装固体 Solid in bulk 组件类型：Type of unit：集装箱 Container 车辆 Vehicle 罐柜 Porta

5、ble tank 开敞式 Open 封闭式 Close 如适合，在方格内划“”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确地填写了正确运输名称、危规编号、分类、危险性和应急措施，需附单证齐全。包装危险货物，包装正确、质量完好；标记、标志/标牌正确、耐久。以上申报准确无误。Declaration:I hereby declare that the contents of declaration are fully and accurately described above by the proper shipping name,UN No.,Class and EmS No.The

6、goods are properly packaged,marked,labeled/placarded and are in all respects in good condition for transport by sea.申报员（签字）：申报单位签章 证书编号:年 月 日 主 管 机 关 签 注 栏：Remarks by the Administration:紧急联系人姓名：Emergency Contart Persons Name：电话：Tel：传真：Fax：电子邮箱：Email：船舶载运危险货物申报单船舶载运危险货物申报单 Declaration Form for Danger

7、ous Goods Carried By Ships(包装/固体散装危险货物)(Packaged/Solid in Bulk)船 名：航 次：进港 始 发 港：抵 港 时 间：Ships name：VoyageNo.：Berthing Port of Departure：Time of Arrival：国 籍：经 营 人：出港 作 业 泊 位：装 货 时 间：Nationality：Manager：Departure Berth：Time of Loading：货物正确运输名称 Proper Shipping Name of the Goods 种类/性质 Category/Property

8、危规编号 UN No.装运形式 Means of Transport 件数 Number of Package 总重量 Weight in Total 卸货港 Port of Discharging 装载位置 Location of Stowage 备注 Remarks 兹声明根据船舶装载危险货物安全和防污染规定，本轮具备装载上述货物的适装条件，货物配装符合要求，货物资料齐全。申报内容准确无误。I hereby declare that,in accordance with the provisions of the safe transportation of dangerous goods

9、 by ships and pollution prevention,this ship has met the requirements of fitness for carrying the above declared goods;Cargo stowage is Properly planned according to the tequirements;The documentation of the cargo is Complete and the contents of the declaration are true and correct.附送以下单证、资料 The following documents and information are submitted in addition.轮船长/申报员：船舶/代理人（盖章）Master/Declarer：Ship/Agent(Seal)船长/申报员证书编号：日期：Certificate No.：Date：主 管 机 关 签 注 栏：Remarks by the Administration:紧急联系人姓名 Emergency Contart Persons Name 电话 Tel 传真 Fax 电子邮箱 Email