Biological Substance Category B (UN3373) Shipper’s Declaration Form

Biological Substance Category B (UN3373) Shipper’s Declaration Form
Complete this form to declare and document the shipment of Biological Substance Category B (UN3373) in accordance with regulations.
Shipper’s Full Name
First NameLast Name
Shipper’s Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Consignee’s Full Name
First NameLast Name
Consignee’s Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Shipment
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Number of Packages
Description of Contents
Mode of Transport
Emergency Contact Name & Phone
I hereby declare that the contents of this consignment are properly packaged, labeled, and in proper condition for transport as required by regulations.
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