Instructions For Use of the

Appendix 11-C Shipper’s Declaration for Dangerous Goods

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Appendix 11-C Shipper’s Declaration for Dangerous Goods

Insert a copy of your State Shipper's Declaration for Dangerous Goods form

Appendix 11-D Notification to Pilot-in-Command

Notification to Pilot-in-Command

Base

Date

Aircraft

 Passenger Aircraft

 Cargo Only Aircraft

The Dangerous Goods listed below have been loaded on this aircraft

AWB No.

Destination

No. of Packages

Shipper

No.

Class

Packing Group

Weight

Loading Location

I certify that the Dangerous Goods listed above have been loaded according to the applicable regulations and that the packages were intact and not damaged or leaking.

Name

Signature

I am aware of the Dangerous Goods loaded on this aircraft and their location.

PIC Name

Signature

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