1. Healthcare

(Provide at least two copies to the airline.)
SHIPPER'S DECLARATION FOR DANGEROUS GOODS
Shipper
Air Waybill No.
Institución
Dirección
Laboratorio
TE/CEL
Dr/a
Consignee
Page
1 of
1 Pages
Shipper's Reference Number
INEI-ANLIS "Carlos G Malbran"
Velez Sarsfield 563 - CABA
CP 1281
(011) 4303-2333
382/2817
int 107
Dra. Mariana
Viviana Pichel
Molina/ Valeria Martínez
Two completed and signed copies of this Declaration must
WARNING
be handed to the operator
Failure to comply in all respects with the applicable
Dangerous Goods Regulations may be in breach of the
applicable law, subject to legal penalties. This
Declaration must not, in any circumstances, be completed
and/or signed by a consolidator, a forwarder or an IATA
cargo agent.
TRANSPORT DETAILS
This shipment is within the
limitations prescribed for:
(delete non applicable)
Airport of Departure:
Aer0puerto
PASSENGER XXXXXXXXXX
AND CARGO XXXXXXXXXX
AIRCRAFT XXXXXXXXXX
Shipment type:
Airport of Destination:
(delete no-applicable)
NON-RADIOACTIVE
TLC
XXXXXXXXXXX
NATURE AND QUANTITY OF DANGEROUS GOODS
Dangerous Goods Identification
Proper Shipping Name
Class or
UN or
Packing Subsi-
Division
ID No.
Group
Quantity and Type of packing
Packing
diary
Authorization
Inst.
Risk
Sustancia infecciosa que
afecta a los humanos
6.2
UN
2814
---
---
Una caja de carton, conteniendo
una caja de poliestileno
expandido
Contenido TOTAL = XX ml
1
Additional Handling Information
XXXX PICHEL
TE XXXXX
CEL XXXX INT 107
EN CASO DE DAÑO INFORMAR INMEDIATAMENTE A LA DRA. MARIANA
54-11-4303-2333
I hereby declare that the contents of this consignment are fully and accurately
described above by the proper shipping name and are classified, packaged, marked
and labelled/placarded, and are in all respects in proper condition for transport
according to the applicable international and national governmental regulations.
Name/Title of Signatory
DR/A.XXXX. Mat. Nº XXX
Place and Date
XXXX- Fecha
5 DE ENERO 2011
Signature
file name: Formulario Declaración DG_cat A
eted
file name: Formulario Declaración DG_cat A