____________________________________________________________
Company Letterhead 公司抬头
(MUST be issued by the packer or supplier of the goods and MUST include the company’s name AND
address)
出此声明者必须是货物最终装箱人或者货物供应商。必须包括公司名称和地址
PACKING DECLARATION 包装声明
Vessel Name:…船名…………… Voyage Number:…航次……………..
Consignment identifier or numerical link…………相关号码（集装箱号，发票号或者提单号任意一种）PROHIBITED PACKAGING MATERIAL STATEMENT
有无违禁包装材料的声明
(Prohibited packaging material such as straw, bamboo, peat, hay, chaff, used fruit & vegetable cartons) （违禁包装材料包括稻草，竹子，泥炭，干草，谷壳，使用过的蔬果纸板箱）
Q1 Have prohibited packaging materials or bamboo products been used as packaging or dunnage in the consignment covered by this document?
(/衬垫物）
A1 YES 有NO 没有
TIMBER PACKAGING/DUNNAGE STATEMENT
有无木质包装材料（包括填充或垫底材料）的声明
(Timber packaging/dunnage includes: crates, cases, pallets, skids, and any other timber used as a shipping aid.) （木质包装/货垫包括：木质板条箱，盒子，托盘，垫木，以及其他木制品，以作辅助运输之用者）
Q2a Has solid timber packaging/dunnage been used in consignments covered by this documen
在托运货物中中，有没有木质包装/货垫？
A2a YES有NO没有
TREATMENT CERTIFICATION (ONLY IF TIMBER/DUNNAGE IS DECLARED IN QUESTION 2)
处理证明（在第二个问题中回答“有“时请回答以下问题）
Q3 All timber packaging/dunnage used in the consignment has been (Please Indicate below) 在托运中使用的所有的木质包装/货垫，是否（请在下列情况中打勾）
Treated and Marked in compliance with ISPM 15
处理过并打上了ISPM15认可的标记
Or或者
include中文
Treated in compliance with DAFF Treatment
Requirements
(With accompanying Treatment Certificate)
根据DAFF处理要求处理过了（要求提供处理证明）
Or或者
Not Treated  没有处理过
CONTAINER CLEANLINESS STATEMENT (for FCL/X consignments only - statement to be removed from document when not relevant)集装箱清洁申明（此申明只适用于FCL/X, 如若不是，请删除此申明）
The container(s) covered by this document has/have been cleaned and is/are free from material of ani
mal and/or plant origin and soil.此集装箱已经经过清洁处理，不含任何动植物以及土壤等杂物
Signed: ....公司代表手写签名.及盖公章....................Printed name:........公司代表正楷或印刷体姓名......................................
(Company Representative)
Date of issue:............签发日（日/月/年）......（必须是船开前的日期）.. (DD/MM/YYYY)