FORMIC ACID

UN 1779
CONSIGNEE:
J SMITH PLC
NEW FACTORY
MELBOURNE
VICTORIA
AUSTRALIA 8

SHIPPER:
J SMITH PLC
THE FACTORY
NEW TOWN u 4G/X30/S/01
CO SHIRE
ENGLAND
n GB/3456
SHIPPER'S DECLARATION FOR DANGEROUS GOODS
S HIPPERS DECLARATION FOR DANGEROUS GOODS

Shipper C h e m ila b Ltd Air Waybill No. 010-1234 2222

Va lle y Esta te , C ity Ro a d Page 1 of 1 Pages
Yo urtow n , C o un tysh ire
Y10 7Q P, En g la nd Shipper's Reference Number
(Optional)

Consignee
Re se a rc h En te rp rise s
P O Bo x 1400
O tta w a , O n ta rio CONSULSADO
C a na d a K8D 5R2
AIRWAYS
Two completed and signed copies of this Declaration must WARNING
be handed to the operator
Failure to comply in all respects with the applicable
TRANSPORT DETAILS Dangerous Goods Regulations may be in breach of
This shipment is within the the applicable law, subject to legal penalties. This
Airport of Departure
limitations prescribed for Declaration must not, in any circumstances, be com-
(delete non applicable) pleted and/or signed by a consolidator, a forwarder or
CABO an IATA cargo agent.
PASSENGER
XXXXXXXXX CARGO
AND CARGO
XXXXXXXXX AIRCRAFT VERDE - SAL
AIRCRAFT
XXXXXXXX ONLY

Shipment type (delete non applicable)

Airport of Destination FAO
NON-RADIOACTIVE XXXXXXXXXXX
RADIOACTIVE

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods Identification

Class UN Pack- Subs- Quantity and Packing
Proper Shipping Name Authorization
or or ing idiary type of packing inst.
Divi- ID Group Risk
sion No.

Ac rid in e 6.1 UN 2713 III 2 Pla stic je rric a n s x 50 kg 619

Fo rm ic a c id 8 UN 1779 II 1 Fib re b o a rd b o x x 20 L 812

Ac e tyl c hlorid e 3 UN 1717 II 8 1 Wo o d e n b o x x 2 L 308

Additional Handling Information

I hereby declare that the contents of this consignment are fully and accurately Name/Title of Signatory
described above by the proper shipping name, and are classified, packaged, J Sm ith Dire c to r
marked and labelled/placarded, and are in all respects in proper condition for
transport according to applicable international and national governmental Place and Date
regulations. Yo urto w n 26 Ja nu a ry 2011
Signature
(see warning above) ZÉ
SHIPPER'S DECLARATION FOR DANGEROUS GOODS

S HIP PERS DECLARATION FOR DANGEROU S GOODS

Shipper Air Waybill No. 010-1234 2222

C h e m ila b Lt d
Va lle y Est a te , C it y Ro a d Page 1 of 1 Pages
Yo urt o w n, C o unt ysh ire Shipper's Reference Number
Y10 7Q P En g la nd
(Optional)

Consignee
Re se a rc h Ent e rp rise s
P O Bo x 1400
O t t a w a , O nt a rio CONSULSADO
C a n a d a K8D 5R2
AIRWAYS
Two completed and signed copies of this Declaration WARNING
must be handed to the operator
Failure to comply in all respects with the
TRANSPORT DETAILS applicable Dangerous Goods Regulations may be
This shipment is within the Airport of Departure in breach of the applicable law, subject to legal
limitations prescribed for penalties. This Declaration must not, in any
(delete non applicable) circumstances, be com-pleted and/or signed by a
XXXXXXXX
PASSENGER CARGO SAL - C V consolidator, a forwarder or an IATA cargo agent.
AND CARGO
XXXXXXXX AIRCRAFT
AIRCRAFT
XXXXXXXX ONLY

Shipment type (delete non applicable)

Airport of Destination FAO - PRT
NON-RADIOACTIVE XXXXXXXXXXXX
RADIOACTIVE

NATURE AND QUANTITY OF DANGEROUS GOODS

Proper shipping name, Class or Division, UN Number or Identification Number, Packing Group (if required),
and all other required information.

Ac rid in e , 6.1, UN 2713, III

2 Pla stic je rric a n s x 50 kg
619

Fo rm ic a c id , 8, UN 1779, II
1 Fib re b o a rd b o x x 20 L
812

Ac e tyl c h lo rid e , 3, UN 1717, II, 8

1 Wo o d e n b o x x 2 L

Additional Handling
Information

I hereby declare that the contents of this consignment are fully and Name/Title of Signatory
accurately described above by the proper shipping name, and are J Sm it h Dire c t o r
classified, packaged, marked and labelled/placarded, and are in all
Place and Date
respects in proper condition for transport according to applicable Yo urt o w n 26 J a n u a ry 2011
international and national governmental regulations.
Signature
(see warning above)
ZÉ
 NOTIFICATION TO CAPTAIN (NOTOC) (MANUALLY PRODUCED)

CONSULSADO AIRWAYS

DANGEROUS GOODS - NOTIFICATION TO CAPTAIN

STATION OF LOADING FLIGHT NO. AIRCRAFT REGN. DATE PREPARED BY:
Cabo Verde - Sal IC 1001 G-AAAA 26 January 2011 Signed: ............... Nascimento
DANGEROUS GOODS *COMPATIBILITY GROUP (FOR EXPLOSIVES) MUST BE SHOWN IN CLASS COLUMN

Station of Air waybill no. No. of UN no. Proper shipping Class or Subsidiary Net quantity or TI Packing IMP ICAO Loading
unloading packages name division * risk & category of group position
each package code (X)

YOW 010-1234 2 UN ACRIDINE 6.1 50 kg III RP X M / Deck

2222 2713 B C4
YOW 010-1234 1 UN FORMIC ACID 8 20 L II RC X M / Deck
2222 1779 M C4
YOW 010-1234 1 UN ACETYL 3 8 2L II RF X M / Deck
2222 1717 CHLORIDE L C4

THE ABOVE DANGEROUS GOODS ARE BEING CARRIED IN ACCORDANCE WITH THE ATTACHED STATE EXEMPTION(S) (delete if not-applicable)
I CONFIRM THAT THE ARTICLES LISTED ABOVE WERE LOADED AS SHOWN AND THERE CAPTAINS SIGNATURE:
WAS NO EVIDENCE OF ANY DAMAGED OR LEAKING PACKAGES.
George
Signed:...........OK Done Status:..........LOADER