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Shipper's Declaration Form

This document is a shipper's declaration form providing information about a cargo shipment of thermal coal from Newcastle, Australia to Shanghai, China. It includes: 1) General information about the shipper, consignee, carrier, transport details, instructions, and ports of departure and destination. 2) Cargo information including a description of Huntington thermal coal in bulk sized 0-50mm with approximately 0.6% sulfur, and that the cargo is not liable to emit methane or liquefy. 3) The signatory declares that the cargo is fully and accurately described and test results are correct to their knowledge, on behalf of the shipper Yancoal Australia Sales Pty Ltd.

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Yan Laksana
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1K views1 page

Shipper's Declaration Form

This document is a shipper's declaration form providing information about a cargo shipment of thermal coal from Newcastle, Australia to Shanghai, China. It includes: 1) General information about the shipper, consignee, carrier, transport details, instructions, and ports of departure and destination. 2) Cargo information including a description of Huntington thermal coal in bulk sized 0-50mm with approximately 0.6% sulfur, and that the cargo is not liable to emit methane or liquefy. 3) The signatory declares that the cargo is fully and accurately described and test results are correct to their knowledge, on behalf of the shipper Yancoal Australia Sales Pty Ltd.

Uploaded by

Yan Laksana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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SHIPPER’S DECLARATION

Note: This form is not applicable if the cargo to be loaded requires a declaration under the requirements of SOLAS 1974,
Chapter VII/R4, MARPOL 73/78 Annex III/R4, and the IMDG Code Chapter 5.4 (Documentation). This form meets the
requirements of SOLAS 1974, Chapter VI, Reg 2 (for general cargo, cargo in cargo units, cargo carried in solid bulk) and
the IMSBC Code, section 4.2.

General Information
Shipper Transport document number
YANCOAL AUSTRALIA SALES PTY LTD
Consignee Carrier IMO #
SHANGHAI TIME SHIPPING CO., LTD MV " NEARCHOS " 9172571
Name/means of transport Instructions or other matters
MV " NEARCHOS " VIA SEA
Port/place of departure PLEASE REFER TO THE LATEST EDITION OF THE
NEWCASTLE, AUSTRALIA
IMSBC CODE
Port/place of destination
SHANGHAI PORT, CHINA OR ANY MAIN PORT IN MAINLAND CHINA

Cargo Information
General description of the cargo ( For solid bulk cargo type of material/particle size) –
HUNTINGTON THERMAL COAL IN BULK SIZE: (0 X 50MM) SULPHUR (approx) 0.60 %
Gross mass (kg/tonnes) Relevant special properties of the cargo
(eg highly soluble in water. For solid bulk cargo, see Section 4 of the
General cargo: IMSBC Code)
CARGO IS NOT LIABLE TO EMIT SIGNIFICANT AMOUNTS OF
Cargo unit(s): METRIC TONNES METHANE. CARGO IS NOT CONSIDERED A CARGO WHICH
Bulk cargo: 68,000 METRIC TONNES +/- 10 PCT MAY LIQUEFY DURING THE VOYAGE. CARGO IS NOT
CONSIDERED LIABLE TO SPONTANEOUS COMBUSTION.

Solid Bulk Cargo Information


BCSN
COAL IN BULK
Specification of bulk cargo (if applicable) Group of the cargo

Stowage factor: 1.161 (CUBIC METRES/TONNE) Group A and B*

Angle of repose: Group A*


Group B
Trimming procedures: FREE POUR SPOUT
Group C
If potential hazard chemical properties*: - MHB * For cargoes which may liquefy
*eg: Class, UN number or MHB (Group A and Group A and B cargoes)

Classification relating to MARPOL Annex V Transportable moisture limit

Harmful to the marine environment N/A


Not harmful to the marine environment Moisture content at shipment

HME information is for the Master to consider in relation to how cargo residues N/A
generated by this cargo may be handled and disposed of after discharge of the cargo.
Additional certificate(s) (if required)
Certificate of moisture content*
Certificate of transportable moisture limit*
Weathering certificate
Exemption certificate
Approval Certificate for the procedures for sampling, testing and controlling the moisture
content for a solid bulk cargo that may liquefy (see 4.4.3 of the IMSBC Code)
Other (specify):
*May be combined into a single certificate

Declaration
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.
Name/status, company/organisation of signatory Place and date Signature on behalf of shipper
YANCOAL AUSTRALIA SALES PTY LTD NEWCASTLE, 03/05/2017 SHERRIE THOMPSON
Shippers' may deliver this declaration by fax or other electronic means. In any electronic transmission, where the signature
of the declarant cannot be transmitted, full name of the declarant in capital letters must be provided on the form.
AMSA 268 (1/15)

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