危险货物申报单样本word.docx

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1、附件一船舶载运危险/污染危害性货物申报单（包装货物）船舶载运危险/污染危害性货物申报单DeclarationFormHazardousGoodsCarriedByShip（包装货物）（Packaged）申报单编号:船名：航次：口进港上一港（上一出发港）/下一港（下一目的港）：抵离港时间：Shi,sname：VoyageNo:ArrivalPortofPrev/Next:TimeofArrival:国籍：经营人：口出港作业泊位：作业时间：Nationality:Manager:DepartureBerth:TimeofLoading:货物正确运输名称ProperShippingNameofthe

2、Goods类别/性质ClassZProperty危规编号UNNo.装运形式MeansofTransport件数NumberofPackages总重量（千克）WeightinTotal卸货港PortofDischarging装载位置1.ocationofStowage（编号&规格&贝位X-Y-Z&箱内件数&是否拼箱）备注Remarks兹声明根据船舶装载污染危害性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。申报内容正确无误。Iherebydeclarethat,inaccordancewiththeprovisionsofthesafetransporta

3、tionofsolidbulkcargoesbyshipsandpollutionprevention,thehasmettherequirementsoffitnessforcarryingtheabovedeclaredgoods;Cargostowageisproperlyplannedaccordingtotherequirements;documentationofthecargoiscompleteandthecontentsofthedeclarationaretrueandcorrect.备注信息（remarks）：附送以下单证、资料：Thefollowingdocuments

4、andinformationaresubmittedinaddition.申报单位：船长/申报人员：船舶/代理人（盖章）MasterZDeclarer:Ship/Agent（Seal）:船长/申报员证书编号：日期：CertificateNo:Date:主管机关签证栏RemarksbytheAdministration电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPersonsName,Tel,FaxandE-mail:此申报单一式三份，其中两份申报人留持和分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbemadein

5、tripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.附件二船舶载运危险/污染危害性货物申报单（散装液体）船舶载运危险货物/污染危害性货物申报单DeclarationFormForHazardousGoodsCarriedByShips（散装液体物质）（BulkLiquids）申报单编号：船名：航次：口进港上一港（上一出发港）/下一港（下一目的港）：抵离港时间：Shio,sname:VbvageNo:BerthingPortofDeoarture:Timeof

6、Arrival:国籍：一经管人：一口出海作业泊位：-作业时间：Nationality:Manager:DepartureBerth:TimeofLoading:货物正确运输名称ProperShippingNameofTheGoods种类/性质Class/property规号N6危编UN数量(吨)Quantity(Ton)液货舱编号Numberoftanks液舱惰化(是/否)Tankinerting(yesno)装卸货物温度(eC)CargoHandlingTemPeralUre(C)装/卸货港PortofLoading/Discharging备注remarks本轮液舱中存有下述压载水/污水：T

7、heballast/bilgeWaterremainedintanksOnboard:舱室编号TankNo.水质种类kindsofwater数量Quantity注明该舱室为专用/清洁压载舱或液货舱Indicatingwhetherthetankissegrogted/cleanballasttankorcargotank备注remarks本轮港备在港口进行下述作业，并将按规定另仃申请：Thisshipplanstocarryoutthefollowingoperation(s)inportandapplicationwillbesubmittedseparatelyaccordingtothe

8、relevantprovisions:1.清洗液货舱作业(水洗)口是/口否2.使用清洁剂/添加剂洗舱口是/口否tankwashing(waterwash)YesNotankwashingbydetergent/additivesYesNo3.原油洗舱口是/口否4.驱气作业口是/口否crudeoilwashingYesNogasfreeingYesNo5.向港口接收设施排放含油/有害物质的洗舱水/混合物、预杆吨(M3)disposaloftankwashingwater/watercontainingharmfulsubstances/mixturesintoportreceptionfacil

9、ities,estimatedquantity_tons(M3)兹声明根据船舶装载固体散装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。Theredeclarethat,ininaccordancewiththeprovisionsofthesafetransportationofsolidbulkcargoesbyshipsandpollutionprevention,thisshiphasmettherequirementsoffitnessforcarryingtheabovedeclaredgoods;Cargostowagei

10、sproperlyplannedaccordingtotherequirements;Thedocumentationofthecargoiscompleteandthecontentsofthedeclarationaretrueandcorrect.备注信息(remarks)：附送以下单证、资料：Thefollowingdocumentsandinformationaresubmittedinaddition:申报单位：船长/申报人员：船舶/代理人(盖章)MasterZdeclarer:Ship/Agent(Seal)船长/申报人员证书编号：日期：CertiticateNo:Date:主管

11、机关签证栏RemarksbytheAdministration电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：JergencyContactpersonsN肛ne,TFa%andE-mail:此申报单二式三份，其中两份申报人留持和分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.附件三船舶载运固体散装货物声明书船舶载运固体散装货物声明书Declarat

12、ionFormforSolidBulkCargoesCarriedByShip申报单编号:船名：Ship,sName:航次：VoyageNo.:口进港Arrival上一港（上一出发港）/下一港（下一目的港）：PortofPrev/Next:抵离港时间：TimeofArrival:国籍：经营人：口出港作业泊位：作业时间：Nationality:Manager:DepartureBerth:TimeofLoading:散装货物运输名称BulkCargoShippingName组别Group类别Class危规编号UNNo.总重量(吨)WeightinTotal(Ton)卸货港PortofDischa

13、rging装载位置1.ocationofStowage备注Remarks兹声明根据船舶装载固体散装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。Iherebydeclarethat,inaccordancewiththeprovisionsofthesafetransportationofsolidbulkcargoesbyshipsandpollutionprevention,thisshiphasmettherequirementsoffitnessforcarryingtheabovedeclaredgoods;Cargostow

14、ageisproperlyplannedaccordingtotherequirements;Thedocumentationofthecargoiscompleteandthecontentsofthedeclarationaretrueandcorrect.备注信息(remarks):附送以下单证、资料Thefollowingdocumentsandinformationaresubmittedinaddition.申报单位：船长/申报员：船舶/代理人(盖章)Master/Declarator:Ship/Agent(Seal)船长/申报员证书编号：日期：CertificateNo.:Dat

15、e:主管机关签证栏RemarksbytheAdministration电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPerson,sName,TelephoneNo.,Fax,andE-mail:此申报单一式三份，其中两份退申报人留持并分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.中华人民共和国海事局监制附件四危险

16、/污染危害性货物安全适运申报单(包装货物)危险货物/污染危害性货物安全适运声明书DeclarationonSafetyandFitnessofDangerousGoods/HazardousGoods(包装货物)(Packaged)进港ArriVal/出港DePartUre申报单编号:发货人：Shipper：收货人：Consignee:承运人Carrier船名和航次：Ship,sname&VoyageNO.:装货港：PortofLoading:卸货港：PortOfDischarging:货物标记和编号，如适用，组件的识别符号或登记号：Marks&Nos,oftheGoods,ifapplica

17、ble,identificationorregistrationnumber(s)Oftheunit提单号：装载位置(编号&规格&贝位X-Y-Z&箱内件数&是否拼箱)：正确运输名称Propershippingname：补充说明：危险类别IMOhazardclass/division：危规编号UNnumber：包装类packaginggroup：闪点(闪杯)flashpoint(Cc.c.):应急措施编号EmSNo：包件的种类和数量numberandkindofpackages：控制及应急温度controlandemergency：货物为海洋污染物identificationofthegoods

18、asMARINEPOLLUTANT*：总重(kg)Totalweight(kg)净重/净量Netweight(kg)交付装运货物的形式：Goodsdelivedas: 杂货Breakbulkcargo 成组件Unitizedcargobox 散货包装Bulkpackages 散装固体Solidinbulk组件类型Typeofunit: 集装箱Container 车辆Vehicle 罐柜Portabletank MEGC 开敞式Open 封闭式Close如适合，在方框内划“J”Insetu,inappropriatebox*仅使用专利商标/商品名称是不够的，如适合：(1)应在品名前加“废弃物”；

19、(2)“空的未经清洁含有残余物一上一次盛装物”；(3)“限量”*如需要，见国际危规第2卷第3.4.6款*需要时*Proprictarytradenamesalonearenotsufficient.Ifapplicable:(1)theworldWASTE”shouldproceedname;(2)“EMPTYUNCLEANEDorRESIDUE-LASTCONTAlNEDtoyLIMITEDQUANTITYtheshouldbeadded.*Whenrequiredinitem3.4.6,volume2oftheIMDGCode;*Whenrequired附送以下单证、资料：Thefollo

20、wingdocuments(s)andinformationaresubmitted:在某种情况下，需提供特殊资料证书，详见国际危规第1卷第544节。circumstancesspecialinformationcertificatesarerequired,seeparagraph5.4.4,volume1ofIMDGCode.兹声明:上述拟交付船舶装运的危险货物/污染危害性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:Iherebydecla

21、rethatthecontentsofthisdeclarationarefullyandaccuratelydescribedabovebythepropershippingname,UNNo.,ClassandEmSNo.Thegoodsareproperlypackaged,marked,labeled/placardedandareinallrespectsingoodconditionfortransportbysea.备注信息(remarks):申报人员姓名：申报单位签章Declarer(Signature):SealofDeclarationUnit申报人员培训备案编号：年月日N

22、o.:YearMonthDate主管机关签注栏：RemarksbytheAdministration:电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPerson,sName,TcI,FaxandE-mail:此申报单一式三份，其中两份申报人留持和分送承运船舶，一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandtheshiprespectively.附件五危险/污染危害性货物安全适运申报

23、单(散装液体)危险货物/污染危害性货物安全适运声明书DeclarationonSafetyandFitnessof,DangerousGoods/HazardousGoods(散装液体物质)(BulkLiquids)进港ArriVaI/出港DePartUre申报单编号:发货人(名称、地址)：Shipper(name,address):承运人名称(或其代理人)：Carrier(oritsagent)：货物种类(在相应的方框内填上“J”)Kindsofgoods(InsertJinappropriatebox)：散化口液化气口散装油类BulkchemicalLiquefiedgasBulkoil船

24、名和航次：Shipsname&VoyageNO.:装卸港：PortofLoading:卸货港：PortofDischarging:正确运输名称ProperShippingName:补充说明：危险类刖HazardCategory:污染物类别IMopollutionCategory；危规编UNNo:数量Quantity;闪点(闭杯)FlammabilityLimits:可燃上下限FlammabilityLimits;自燃温度AutoignitionTemperature:沸点BoilingPoint;液体相对密度RelativeDensityofLiquid:黑气密度DensityofVapour

25、:意气;力(20C37.8C)DensityofVapour:永中溶解度SolubilityinWater:粘度Viscosity:酸度Acidity:TLV(ppm)：LC50:1.D50(口服/皮肤)LD50(oralskin):导电率(psm):液化温度和力气Temperature&PressureOfLiquefaction:提单号：注：以上货物特性根据货物种类填写合适项目。Remarks:Pleasefillintheproperlumnswithcargoproperties不能仅使用贸易或专利名称Accordingtothecargoclassification.Propriet

26、ary/tradenamesalonearenotsufficient.附加资料：Additionalinformation:货物反应性：Reactivityofthecargo:应急措施(溢漏需采取的措施、有效灭火剂、其它应急措施)：Emergencymeasures(Themeasurestakenforspill,effectivefireextinguishingagentandotheremergencymeasures):人员防护：PersonnelProtection:声明：已按规定全部并准确地填写了上述拟交付船舶载运的危险货物/污染危害性货物的正确运输名称、危规编号、危险特性等

27、应申报事项、货物在各方面均符合安全适运条件。以上申报准确无误。Declaration:Iherebydeclarethatthedeclarationisfullyandaccuratelydexcribedabovebythepropershippingname,UNNo.,hazardsproperty,etc.Thegoodsisinallrespectsingoodconditionfortransportbysea.备注信息(remarks)：申报员姓名：申报单位名称(签章)Declarer(Signature):NameofDeclareUnit(seal)申报人员培训编号：填报日

28、期：No.:ApplyingDale:主管机关签注栏：RemarksbytheAdministration:电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPerson,sName,Tel,FaxandE-mail:此申报单一式三份，其中两份申报人留持和分送承运船舶，一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandtheshiprespectively.附件六固体散装货物安全适运声明书

29、固体散装货物安全适运声明书DeclarationFormforSolidBulkCargoes进港ArriVa1口出港Departure申报单编号:散装货物运输名称(BCSN)：托运人：(Shipper):运输单证编号(提单号)：(TransportdocumentNumber):收货人(COnSignee)承运人(Carrier)：运输工具的名称/方式：(Name/meansoftransport):出发港口/地点：(Port/placeofdeparture):指南或其他事项：(Instructionsorothermatters):目的港口/地点：(Port/placeofdestina

30、tion):货物的一般性描述：(货物种类/颗粒尺寸)Generaldescriptionofthecargo(Typeofmaterial/particlesize)总重(千克/吨)：Grossmass(kg/lonnes):如适用，散装货物的特殊说明(SPeCifiCatiOnSofbulkcargo,if叩PliCabIe:)：积载因数(StOWagefactor)：如适用，静止角(Angleofrepose,ifapplicable)：平舱程序(Trimmingprocedures)：如有潜在危险性，其化学特性(ChemiCaIProPerlieSifPolentiaIhaZard*)：

31、*例如：类别和联合国编号或仅在散装运输时具有化学危险的物质(*e.g.,Class&UNNo.or“MHB”)货物组别(GrOUPofthecargo) A和B组*(GrOUPA&B*) A组*(GroupA*) B组(GroUPB) C组(GroUPC) 易流态化货物(A组和A及B组货物) Forcargoeswhichmayliquefy(GroupAandGroupAandBcargoes)适运水份极限(TransportableMoistureLimit)运输时的水份含量(Moisturecontentatshipment)根据MARPOL附则V分类对海洋环境有害对海洋环境无害货物相关

32、特殊性质(例如可快速溶于水)Relevantspecialpropertiesofthecargo(e.g.,highlysolubleinwater)额外证书Additionalcertificate(s)* 水份含量和适运水份极限证书CertiflCateofmoisturecontentandtransportablemoisturelimit 风化证书(Wealheringcertificate) 免除证书(EXemPtiOncertificate) 其它(需说明)Other(specify)*如需要(*Ifrequired)声00(DECLARATION)兹声明：托运货物已完全并准确

33、地予以说明。据我所知并相信所给出的试验结果和其它说明准确无误,可被视为拟装货物的代表。(Iherebydeclarethattheconsignmentisfullyandaccuratelydescribedandthatthegiventestresultsandotherspecificationsarecorrecttothebestofmyknowledgeandbeliefandcanbeconsideredasrepresentativeforthecargotobeloaded.)备注(remarks):签字人姓名/身份，公司/组织名称Name/status,CompanyZo

34、rganizationofsignatory地点和日期Placeanddate代表托运人签字Signatureonbehalfofshipper中华人民共和国海事局监制附件七液货船水上过驳作业申请书液货船水上过驳作业申请书申请人代理人作业船舶名称国籍联系电话联系人申请过驳方式-单航次过驳口-特定水域多航次过驳口附送材料L船舶作业应急预案、船舶作业方案、拟采取的保障措施和防治污染措施等口2 .过驳作业所需配备的有关设备、器材的清单和辅助船资料，按规定需经检验的设备需提交有关检验证明口3 .拟过驳作业点水域概况和环境状况可行性论证材料口4 .水上储库具备的靠泊船型和尺度口5 .过驳作业水域通航安全

35、评估报告和污染风险的分析报告（适用时）6 .与污染清除作业单位签订的污染清除作业协议（适用时）口7 .作业单位对参与过驳人员的培训证明口8 .拟进行过驳作业的船舶适航证书（卸、装载船舶）口9 .拟进行过驳作业的船舶适装证书或符合证明（卸、装载船舶）口10.拟进行过驳作业的船舶（国际）防止油污证书（卸、装载船舶）IL委托证明及委托人和被委托人身份证明（委托时）口12.海事部门要求的其他附带单证口附件八集装箱装运危险货物装箱证明书集装箱装运危险货物装箱证明书ContainetpackingCetifiacte编号:船名：ShipsName:航次：VoyageNo:目的港：PortofDestina

36、tion:集装箱编号：ContainerSerialNo:箱内所装危险货物DangerousGoodspackedTherein正确运输名称ProperShippingNameoftheGoods货物类别IMDGCodeClass危规编号UNNO包装类PackGroup件数PackageQuantity箱数TotalofContainer总重TotalWeight兹证明：装箱现场检查员已根据国际海运危险货物规则的要求，对上述集装箱和箱内所装危险货物及货物在箱内的积载情况进行了检查。并声明如下：Thisiscertifythatabovementionedcontainer,dangerousg

37、oodspackedthereinandtheirstowageconditionhavebeeninspectedbytheundersignedpackinginspectoraccordingtotheprovisonsofINTER-NATIONALMARITIMEDANGEROUSGOODSCODEandtodeclarethat:1.集装箱清洁、干燥、外观适合装货。1.Thecontainerwasclean,dryandapparentlyfittoreceivethegoods.2.如果托运货物中包括除第1.4类外的第1类货物，集装箱在结构上符合国际危规第1卷第7.4.6节的规

38、定。2.Iftheconsignmentsincludegoodsofclass1exceptdivision1.4,thecontainerisstructurallyserviceableinconformitywithsection7.4.6,volume1oftheIMDGCode.3.集装箱内未装有不相容的物质，除非经有关主管机关按第一卷第7.2.23节的规定批准者外。3.Noincompatiblegoodshavebeenpackedintocontainer,unlessapprovedbythecompetentauthorityconcernedinaccordancewi

39、thsection7.2.2.3,volume1oftheIMDGCode.4.所有包装均已经过外观破损检查，装箱的包件完好无损。4.Allpackageshavebeenexternallyinspectedfordamage,andonlysoundpackageshavebeenpacked.5.所有包件装箱正确，衬垫、加固有理。5.Allpackagesahavebeenexternallyinspectedfordamage,andsecured,dunnaged.6.当散装危险货物装入集装箱时，货物已均匀地分布在集装箱内。6.Whendangerousgoodsaretranspo

40、rtedinbulkpackagings,thecargohasbeenevenlydistributedinthecontainer.7.集装箱和所装入的包件均已正确地加以标记、标示和标题。7.Thecontainerandpackagesthereinareproperlymarked,labelledandplacarded.8.当将固体二氧化碳（干冰）用于冷却目的时，在集装箱外部门断明显处已显示标记或标志，注明：内有危险气体-二氧化碳（干冰），进入之前务必彻底通风。”8.Whensolidcarbondioxide(dryice)isusedforcoolingpurpose,theC

41、ontainerisexternallymarkedorlabeledinaconspicuousplaceatthedoorandwiththewords:tDANGEROUSC02-GAS(DRYICE)INSIDE,VENTILATETHOROUGHLYBEFOREENTERING,.9.对集装箱内所装地每票危险货物，已经收到根据国际危规第卷第5.4.1节所要求地危险货物申报单。9.Thedangerousgoodsdeclarationrequiredinsubsection5.4.1,volume1oftheIMDGCodehasbeenreceivedforeachdangerou

42、sgoodsconsignmentpackedinthecontainer.以上各项准确无误。Thatallstatedabovearecorrect.备注信息（remark）：装箱现场检查员签字：Signatureofpackinginspector:检查地点：PlaceofInspector:装箱现场检查员证书编号：No.ofcertificateofpackinginspector:装箱单位（公章）：Packingunit（seal）:装箱日期：Dateofpacking:签发日期：DateofIssue:紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPersionsName,Tel,FaxandE-mail:此证明书应由装箱现场检查员填写一式两份，份于集装箱装船二天前向海事主管机关提交，另份应在办理集装箱移交时交承运人。lowcopiesofthecertificateshouldbefilledbythepackinginspector.OneshouldbesubnittedtoMaritimeSafefyAdministrationthreedaysPriortoshipmentandtheothershouldbegiventothecarrieroncontainerdelivery.