DANGEROUS GOODS MANIFEST PAGE NUMBER

(As required by SOLAS 74, chapter VII, regulation 5.5, MARPOL 73/78, annex III, regulation 4(3) and chapter 5.4, paragraph 5.4.3.1 of the IMDG Code) (e.g., 5 of 7)

B
NAME OF SHIP IMO NUMBER NATIONALITY OF SHIP MASTER’S NAME

VOYAGE REFERENCE PORT OF LOADING PORT OF DISCHARGE SHIPPING AGENT

Marks & numbers

Booking/ Number UN Packing Subsidiary Flashpoint Marine Mass (kg) Stowage position on
Container ID. No(s). Proper Shipping Name Class EmS
reference number Vehicle reg. No(s). and kind of packages Number group risk(s) (in oC, c.c.) pollutant gross/net board

IMO FAL
Form 7

AGENT’S SIGNATURE ______________________________________________________________ MASTER’S SIGNATURE ________________________________________________________________

PLACE AND DATE _________________________________________________________________ PLACE AND DATE ____________________________________________________________________