BCSN
|
Shipper
|
Transport document number
|
Consignee
|
Carrier
|
Name/means of transport
|
Instructions or other
matters
|
Port/place of departure
|
Port/place of destination
|
General description of the cargo
(Type of material/particle size)
|
Gross mass (kg/tonnes)
|
Specifications of bulk cargo, if
applicable:
|
|
Stowage factor:
|
Angle of repose, if
applicable:
|
Trimming procedures:
|
Chemical properties if
potential hazard*:
|
- * e.g. class & UN No. and/or MHB hazard(s)
|
Group of the
cargo
|
Transportable moisture
limit
|
Group A and B*
|
|
Group A*
|
|
Group B
|
Moisture content at
shipment
|
Group C
|
|
- * For cargoes which may liquefy (group A and group A and
B cargoes)
|
|
Classification relating to MARPOL Annex V
harmful to the marine environment
not harmful to the marine environment
|
Additional
certificate(s)*
|
Certificate of moisture content and transportable
moisture limit
|
Weathering certificate
|
Exemption certificate
|
Other (specify)
|
|
Relevant special properties of the cargo (e.g.
highly soluble in water)
|
|
DECLARATION
|
Name/status,
company/organization of signatory
|
I hereby declare that the
consignment is fully and accurately described and that the given test
results and other specifications are correct to the best of my knowledge and
belief and can be considered as representative for the cargo to be
loaded.
|
Place and
date
|
Signature on behalf of
shipper
|