Hazardous Material Shipping Form

HAZARDOUS MATERIAL SHIPPING FORM SHIPPER'S CERTIFICATION FOR RESTRICTED ARTICLES* (this excludes the shipment of radioactive materials) Warning: Failure to comply in all respects with the IATA Restricted Articles Regulations may be a breach of the applicable law, subject to legal penalties. This Certification shall in no circumstance be signed by an IATA Cargo Agent, consolidator or a forwarder. Cargo Aircraft Only This consignment is within the limitations prescribed (mark one only) Both Cargo and Passenger Aircraft Net Quantity per Package Flash Point (closed cup) For Flammable Liquids Number of Packages Article Number (see Section IV FAR) Proper Shipping Name of Article as shown in Section IV of the IATA Restricted Articles Regulations (RAR) Specify each article separately. Class IATA Packing Note no. Applied °C °F SPECIAL HANDLING INFORMATION I hereby certify that the contents of this consignment are fully and accurately described above by Proper Shipping Name and are classified backed, marked, labeled and in proper condition for carriage by air according to the current Edition of the IATA Restricted Articles Regulations and all other applicable Carrier and Govermental regulations. I acknowledge that I may be liable for damages resulting from any misstatement or omission and I further agree that any air carrier involved in the shipment of this consignment may rely on this Certification. Name and Full Address of Shipper: Name and Title of person Signing Certification: Signature of Shipper (See Warning) Optional Air Waybill No. Airport of Departure Date Airport of Destination * Note: Two completed and signed copies of this Certification shall be handed to Carrier. American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc.