MUST BE ON SHIPPER LETTER HEAD

Shipper VGM Declaration Form

In order to comply with the SOLAS (Safety of Life at Sea) regulation, please complete the below
form to declare the verified gross mass (VGM).
Shipper Name
Shipper Registration Number (GMV#) (Method 2 on
direct carrier contract only)
Booking Number
Port of Loading
Weighing Company Name (Method 1 only)
Weighing Company Authorization Number (Method 1
only)
Weighing Company Address and Contact Details
(Method 1 only)

Container
Number

Date of
weighin
g

Method
used (1 or
2)

Cargo
Weight*

Method 2
Dunnage
Tare weight*
Weight *

Total VGM*

* Please enter weight and unit of measure.

Method 1 would only require the total VGM to be entered
on the table.
Method 2 would require all the others plus the total VGM.

Signature (Electronic signature: Name of signatory in

CAPS)
Signatory Company Name
Signatory Company Contact Details
Date
*Method 1: Upon the conclusion of packing and sealing a container, the shipper may weigh, or have arranged that a third
party weighs, the packed container
Method 2: The shipper (or, by arrangement of the shipper, a third party), may weigh all packages and cargo items,
including the mass of pallets, dunnage and other packing and securing material to be packed in the container, and add the
tare mass of the container to the sum of the single masses.

2016 Property of Expeditors International of Washington, Inc. and its subsidiaries.

By my signature above, I certify that the information I provided in this form is accurate
and complete.

2016 Property of Expeditors International of Washington, Inc. and its subsidiaries.