SHIPPER/EXPORTER DOCUMENT #/BOOKING # EXPORT REFERENCES CONSIGNEE FORWARDING AGENT - REFERENCES POINT & COUNTRY OF ORIGIN NOTIFY PARTY DOMESTIC ROUTNG/EXPORT INSTRUCTIONS PIER ONWARD INLAND ROUTING EXPORTING CARRIER VESSEL PORT OF LOADING PORT OF DISCHARGE FOR TRANSHIPMENT TO: MARKS & NUMBERS Number of Packages GROSS WT. MEASUREMENT Signature Signature DELIVERED BY: Received the above described goods or packages sunbject to all the terms of the undersigned's regular form of Dock Receipt and Bill of Lading which shall constitue the LIGHTER/TRUCK _____________________ contract under which the goods are received, copies of which are available from the carrier on request and may be inspected at any of it's offices ARRIVED:  DATE _________TIME________ FOR THE MASTER BY       :______________________________ UNLOADED DATE________TIME________ DATE: ______________________________ DOCK RECEIPT PARTICULARS FURNISHED BY SHIPPER CROSS OUT STATEMENT BELOW THAT DOES NOT APPLY: This is to certify that the above named materials are properly classified, described, packaged, marked and labeled and are in  proper condition for transportation according to the applicable regulation of the Department of Transportation and IMCO This is to certify that the above named materials do not come within the classification of Dangerous Cargo according to the applicable regulation of the Department of Transportation and IMCO                                                               DESCRIPTION OF PACKAGES AND GOODS