2755 Thamesgate Drive.Mississauga ON, L4T 1G5phone: 905.677.7066Office Hours 9 Am to 4

2755 Thamesgate Drive.Mississauga ON, L4T 1G5Phone: 905.677.7066Office Hours 9 am to 4 pmAfter hours or weekendsWe are open 24 hours7 days a

Motorcycle (UN3166) Declaration Form

I certify that:

This cargo does not contain any unauthorized explosives, incendiaries, or dangerous goods materials;

This cargo does not contain any items from the Prohibited Items Declaration Form;

The motorcycle and all boxes have been left unlocked;

The motorcycle battery is disconnected and the positive terminal is taped (no other batteries or devices of any description are left onboard the motorcycle); and

There is less than one gallon (4 litres) of gas in the tank

The motorcycle will not be shipped if these requirements are not met.

Shipper/Registered Owner: ______

Signature: ______ Date: ______

Shipping Address

Name: ______

Address: ______

City: ______ Province: ______Country: ______

Email: ______ Phone: ______

Destination Address

Name: ______

Address: ______

City: ______ Province: ______Country: ______

Email: ______ Phone: ______

*N.B.: If you do not have a destination address (i.e., you are picking up the motorcycle from the airlinecargo facility) put “c/o [name of airline], Hold for Pick-Up”.

2755 Thamesgate Drive.Mississauga ON, L4T 1G5Phone: 905.677.7066Office Hours 9 am to 4 pmAfter hours or weekendsWe are open 24 hours7 days a

Motorcycle (UN3166) Declaration Form (cont’d)

Indicate the number of motorcycles, how it will be packaged upon drop-off at the airline, and the net weight of each motorcycle.

(_____) As is, fully visible / kg; / kg; / kg
(_____) In a ______box / kg; / kg; / kg
(_____) Shrink-wrapped on pallet(s) / kg; / kg; / kg
(_____) Other(s) ______/ kg; / kg; / kg

The dangerous goods documentation will be issued upon receipt of the signed Prohibited Items Declaration Form, and the Motorcycle (UN3166) Declaration Form.

Cost
$131.95 (total; one-way) / $179.20 (total; round-trip)
Need Return Documentation: / Y / N

Shipping Address (for Return)

Name: ______

Address: ______

City: ______ Province: ______Country: ______

Email: ______ Phone: ______

Destination Address (for Return)ORSame as Shipping Address

Name: ______

Address: ______

City: ______ Province: ______Country: ______

Email: ______ Phone: ______

Billing

I have an account with Dangerous Goods Packing Service

Customer No.: ______PO No.: ______

Credit card

American ExpressMasterCardVisa

Card No.: ______ Expiry: ______

Cardholder’s Name: ______

Cardholder’s Signature: ______

Email completed and signed documents to:

2755 Thamesgate Drive.Mississauga ON, L4T 1G5Phone: 905.677.7066Office Hours 9 am to 4 pmAfter hours or weekendsWe are open 24 hours7 days a

Prohibited Items Declaration Form

Prohibited Items List applicable to all international shipments

(May be applicable to domestic shipments in some instances)

All of the items listed below are strictly prohibited from shipment, and must never be shipped through our services. Failure to abide by this may result in your being prosecuted by the relevant authorities, imprisonment, and/or severe fines. In no case will the available insurances cover any of the prohibited items listed below.

I declare that my shipment does not contain any of the following types of items, including, but not limited to:

•All living animals and/or creatures of every description;

•Human or animal remains or ashes;

•Illegal goods (contraband);

•Firearms, weapons or any item that could be used as a weapon, explosive devices, ammunition or any parts hereof;

•Imitation (replica) or toy firearms;

•Aerosol cans/sprays;

•Dangerous goods of every description;

•Dry ice;

•Engines, generators, and gear boxes;

•Fire extinguishers;

•Life jackets;

•Food products of every description (whether perishable or non-perishable);

•Perishable goods such as, but without limitation, pharmaceutical products;

•Lithium batteries or products containing such batteries;

•Alcoholic beverages of every description;

•Furs, and/or ivory, or items made there from;

•Tobacco, and tobacco products of every description;

•Automotive panels;

•Antiques;

•Fine Art. “Fine Art” means paintings, etchings, pictures, tapestries, and other bona fide works of art, valuable rugs, statuary, marbles, bronzes, rare books, antique silver, manuscripts, porcelains, rare glass and bric-a-brac, collections of books, mixed periodicals, photographs, slides, clippings, and other articles of a similar nature including furnishings;

•Deeds, and/or securities, and/or treasury notes, and/or any other cash equivalents, and/or tickets, and/or vouchers, and/or stamps, and/or duty stamps, and the like;

•Designs, and/or patterns, and/or plans, and/or manuscripts, and all other documents;

•Jewellery, and/or watches of every description;

•Money, and/or coins of every description;

•Precious Metals. “Precious Metals” means silver, gold, platinum, palladium, iridium, osmium, rhodium, and ruthenium;

•Precious Stones. “Precious Stones” means diamonds, emeralds, rubies, and sapphires;

Semi-Precious Stones. “Semi-Precious Stones” means amethyst, aquamarine, aventurine, carnelian, garnet, lapis lazuli, opal, pearls, rose quartz, topaz, and tourmaline.

2755 Thamesgate Drive.Mississauga ON, L4T 1G5Phone: 905.677.7066Office Hours 9 am to 4 pmAfter hours or weekendsWe are open 24 hours7 days a

Prohibited Items Declaration Form (cont’d)

If any of the above listed items are found during the screening process, the carrier reserves the right to refuse the shipment for carriage, and will contact the shipper to pick up the shipment from the warehouse.

Name of Owner/Shipper: ______

Signature: ______ Date: ______