CIRCLE ONE

Ocean Air EXP/ATA PMB

PICK-UP NUMBER DESTINATION PORT CODE

GP NO S R P B M
“Please clearly in capital letters. Do not abbreviate. Exact addresses and names are needed for timely delivery”
FROM: (SHIPPER INFORMATION) TO: (CONSIGNEE INFORMATION)

NUMBER OF GROSS
DESCRIPTION OF PACKAGES & GOODS
PACKAGES CUBIC WEIGHT LOCATION REMARKES &SEAL NO.(s)

TOTAL PCS TOTAL TOTAL WEIGHT

PLEASE READ
DECLARATION PARAGRAPH 13 OVERLEAF DOOR TO DOOR YES NO PRE-PAID RECEIPT NO.
DECLARED VALUE
OF CARGO FOR INSURANCE BROKERAGE YES NO FREIGHT COLLECT
DECLINED ACCEPTED
COMMERCIAL PERSONAL ON ACCOUNT Acct #
SIGNATURE
X_____________________________________________
ALL CARGO TENDERED IS SUBJECT TO SEARCH AND INSPECTION AS PER TSA RULES
I agree to the terms and conditions of this contract. I also declare that the items I am shipping are hereby noted as being: HAZARDIOUS NON-HAZARDIOUS

Customer’s Signature Date:

Shippers’ Security Endorsement (SSE) Shippers’ Identification

PLEASE READ PARAGRAPH 15 OVERLEAF Type of 1st personal ID reviewed
I certify that this cargo does not contain any unauthorized explosives, incendiary devices,
Hazardous materials, ammunition, combustible materials, undeclared weapons or currency. I Matching photo ID Indicate YES NO
consent to screening and/ or search of this cargo. I am aware that this endorsement and original
Number appearing on ID
signature, along with other shipping documents will be retained on file for at least thirty days.
Type of 2nd Personal ID reviewed
__________________________________________ Matching photo ID Indicate YES NO
Signature of Shipper or Authorized Representative Number appearing on ID
Name of person from whom the
cargo was accepted (if different
_______________________________________________________________
from shipper)
Print/ type name of individual wjose signature appears as shipper/ Authorized Representative

Date:

EXAMINED YES NO