FCLLCLPACKINGDECLARATION[Boxestobemarkedintheappropriateplace]VesselName:……………………………………………………………………….………………………VoyageNumber:………...…………………Consignmentidentifierornumericallink……………………………………………………………………….…………………………………PROHIBITEDPACKAGINGMATERIALSTATEMENT(Prohibitedpackagingmaterialsuchasstraw,bamboo,peat,hay,chaff,usedfruit&vegetablecartons)Q1Haveprohibitedpackagingmaterialsorbambooproductsbeenusedaspackagingordunnageintheconsignmentcoveredbythisdocument?A1YESNOTIMBERPACKAGING/DUNNAGESTATEMENT(Timberpackaging/dunnageincludes:crates,cases,pallets,skids,andanyothertimberusedasashippingaid.)Q2a.Hastimberpackaging/dunnagebeenusedinconsignmentscoveredbythisdocument?A2aYESNOISPM15STATEMENTQ2bAlltimberpackaging/dunnageusedintheconsignmenthasbeentreatedandmarkedincompliancewithISPM15A2bYESNOBARKSTATEMENT(Barkistheexternalnaturallayercoveringtreesandbranches.Thisstatementisonlyrequirediftimber/packagingdunnageisdeclaredusingthetimberorISPM15statements.Abarkstatementisrequiredforalltimberpackaging/dunnageincludingISPM15compliantpackaging/dunnage.)Q3Isalltimberpackaging/dunnageusedinthisconsignmentfreefrombark?A3YESNOCONTAINERCLEANLINESSSTATEMENT(forFCL/Xconsignmentsonly-statementtoberemovedfromdocumentwhennotrelevant)Thecontainer(s)coveredbythisdocumenthas/havebeencleanedandis/arefreefrommaterialofanimaland/orplantoriginandsoil.Signed:……………………………………………………………………………………………Printedname:…………………………………………………(CompanyRepresentative)Dateofissue:………………………………………………………………………………(DD/MM/YYYY)
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