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Multimodal Dangerous Goods Form

1 Shipper/Consignor/Sender (full style address is mandatory) 2Transport document number


Exide Industries Limited BOOKING NO:
Exide House 4 Shipper's reference
59/E, Chowringhee Road
Calcutta 700 020, India
5 Freight Forwarder's reference

6 Consigne Carrier:
Amjad Said Trading Est.
Techno Power Systems
BEIRUT, LEBANON
Contact Person: Mr. Amjad Said
Contact No.: 00963933180065 SHIPPER'S DECLARATION
Notifying Party: I hereby declare that the contents of this consignment are fully and accurately
Amjad Said Trading Est. described below by the proper shipping name, and are classified, packaged, marked
Techno Power Systems and labelled/placarded and are in all respects in proper condition for transport
BEIRUT, LEBANON according to the applicable international and national government regulations.
Contact Person: Mr. Amjad Said
Contact No.: 00963933180065
8 This shipment is within the limitations prescribed for: 9 Additional handling information
PASSENGER AND CARGO CARGO ONLY
10 Vessel and Voyage number 11 Port of loading
HALDIA, INDIA
12 Port of discharge 13 Destination
BEIRUT LEBANON
14 Shipping Marks *Number and kind of packages; description of goods Gross mass (kg) Net Mass Cube(m3)
UN : 2794
PSN: NA
Technical Name: LEAD ACID STORAGE BATTERY
Shiping name: BATTERIES, WET, FILLED WITH ACID
IMDG CLASS "8" 54,744.0
0 53412.00
Sub Risk (if any) - NA
KGS KGS
PG : III Marine Pollutant : NA
No.of Packages: 888 Carton Boxes
. Sub risk (if any) :
Flashpoint : NA
EMS Code : F-A,S-B
IMO Label : 8
MFAG Number:8119
2 X 20
Emergency Contact person name/number : Rajib Saha (9903359779)
FCL/FCL
Limited Quantity :
Poisonous inhalation hazard : NO
Notes :
*Fields marked in red are mandatory to fill. Rest as per conditions if amy required.
Total cube (m3)
Other Details
15 Container identification no. 16 Seal number(s) 17 Container size & type 18 Tare mass (kg) 19 Total gross (incl. tare) (kg) 2
2 X 20 FCL 53412.00 KGS

CONTAINER PACKING CERTIFICATE 21 RECEIVING ORGANIZATION RECEIPT


I hereby declare that the goods described above have been Received the above number of packages/containers/trailers in apparent good order
placed/loaded into the container/vehicle identified above in accordance and condition, unless stated hereon: RECEIVING ORGANIZATION RE-MARKS:
with the applicable provisions. **MUST BE COMPLETED AND
SIGNED FOR ALL CONTAINER/VEHICLE LOADS BY PERSON
RESPONSIBLE FOR PACKING/LOADING
20 Name of company(stamp & signature are Haulier's name 22 Name of company (OF
mandatory) SHIPPER PREPARING THIS
EXIDE INDUSTRIES LIMITED NOTE)
EXIDE INDUSTRIES LIMITED

Name/status of declarant Vehicle reg no. Name/status of declarant


Rajib Saha Rajib Saha
Officer Industrial Export. Officer Industrial Export.
Place and date Signature and date Place and date
Kolkata, 18-05-2017 Kolkata, 182-05-2017

Signature of Declarant DRIVER'S SIGNATURE


Signature of Declarant

* DANGEROUS GOODS
You must specify proper shipping name, hazard class, UN No., Packaging group, (where assigned) Marine pollutant and observe the mandatory
requirements, under applicable national and international governmental regulations. For the purpose of the IMDG Code see
5.4.1.** For the purpose of the IMDG Code see 5.4.2.