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AMSA250 Multimodal Dangerous Goods Form(AMSA250 Multimodal危险货物的形式)
MULTIMODAL DANGEROUS GOODS FORM
This form meets the requirements of SOLAS 74 Chapter VII regulation 4 and MARPOL 73/78 Annex III regulation 4.
Note: When this 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. The container/vehicle packing certificate is not required for tanks.
Page 1 of 2
1. Shipper/Consignor/Sender 2. Transport document number
3. Page of pages 4. Shipper’s reference
(page auto-numbers top right)
24 hour contact number: 5. Freight forwarder’s reference
6. Consignee 7. Carrier (to be completed by the carrier)
SHIPPERS DECLARATION (refer to box 22 below)
I hereby declare that the contents of this consignment are fully and
accurately described below by the proper shipping name(s), and
are classified, packaged, marked and labelled/placarded, and are
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