I, on behalf of the authorized person of my company, certify that I am the authorized signatory of the shipper and that the statements made and all information contained herein are true and correct. I understand that civil and criminal penalties, may be imposed for making false and fraudulent statements herein, failing to provide the requested information or for violation of SOLAS.

The shipper will indemnify the receiver of this registration, their servants and agents and hold them harmless in respect of any liability, loss, damage or expense of whatsoever nature resulting from the inaccuracy of the information provided.