If You are a Corporation Cut and Paste on Company Letterhead
(CIRCLE YES OR NO IN THE APPROPRIATE PLACE)CONTAINER #___________ VESSEL NAME / VOYAGE#_____________ BOOKING#_________
STRAW PACKING (Straw packing includes straw, cereal, rice hulls, and other unprocessed plant material.)
Q. Has STRAW PACKING been used in consignment listed above? A. YES NO
TIMBER PACKING (Crates, Cases, Dunnage, Pallets, Skids, and any other timber used as a shipping aid.)
Q. Has TIMBER PACKING been used in the consignment listed above? A. YES NO
IF Yes, has the wood been treated? ............ YES ............ NO
If Yes, How was the wood treated? () Is a certificate available? YES / NO Attach copy of certificate
BARK (External natural layer covering trees and branches.)
Q. If TIMBER PACKING is used, is it FREE FROM BARK? A. YES NO
CLEANLINESS DECLARATION
I also declare that the above container(s) has/have been cleaned and is/are free from materials of animal and/or plant origin and soil.
Signed: Date: Print Name:
FAX TO 877-597-XXXX (888-634-0791) or 305-592-0266 * TEL:305-815-3619
If You are a Corporation Cut and Paste on Company Letterhead
SHIPPERS LETTERHEAD
Include Contact Details: Physical Address
Temperature (C or F)
Duration hrs.
Temperature was held for the duration at the core of the wood.
Government Program Name
Identification Number
Consignment identifier
Description of goods being treated
(including packaging such as pallets, crates, etc.)
Signature: Date:
SHIPPERS LETTERHEAD
Include Contact Details: Physical Address
Temperature: (C or F)
Duration: hours
Timber Thickness: mm / inches
Consignment identifier:
Description of Goods Being Treated:
(including packaging such as pallets, crates, etc.)
Signature: Date: