DOD MULTIMODAL DANGEROUS GOODS DECLARATION

This form may be used as a dangerous goods declaration as it meets the requirements of SOLAS 74, Chapter VII, regulation 54;
MARPOL 79/78, Annex III, Regulation 4.
1. SHIPPER/CONSIGNOR/SENDER 2. TRANSPORT 3. PAGE 1 4. SHIPPER'S REFERENCE (TCN)
DOCUMENT NUMBER OF
PAGES
5. FREIGHT FORWARDER'S 6. CONSIGNEE 7. CARRIER (To be completed by the carrier)
REFERENCE

24-HOUR EMERGENCY ASSISTANCE TELEPHONE NUMBERS:

DOD DOD HAZ CLASS 1 CHEMICAL/BIOLOGICAL WARFARE DOD SECURE HOLDING: DOD RADIOACTIVE
NON-EXPLOSIVE (EXPLOSIVES) ONLY: MATERIAL: 1-800-524-0331 MATERIALS: COLLECT
HAZMAT: COLLECT: DUTY HOURS: OIL/CHEMICAL SPILLS: ARMY: +011 (703) 697-0218
1-800-851-8061/ +011 (703) 697-0218/ DSN: 584-3044, 584-7211, 584-6455 NRC & TERRORIST USAF: (202) 767-4011
Comm: +011 (410) 436-3044, HOTLINE: DLA: 1-800-851-8061
+011-804-279-3131 0219
+011 (410) 436-7211, 1-800-424-8802 AT SEA:
AT SEA: or DSN: 227-0218 +011 (410) 436-6455 AT SEA: COLLECT: 1-804-279-3131
COLLECT: (Watch Officer) AFTER DUTY HOURS: COLLECT: 202-267-2675 USN/MC: Use 24-hour
(804) 279-3131 DSN: 584-2148 emergency response number
Comm: +011 (410) 436-2148 provided by activity.
- Ask for TEU S3
8. THIS SHIPMENT IS WITHIN THE LIMITATIONS PRESCRIBED FOR: (X as applicable) 9. CONTAINER PACKING CERTIFICATE OR
MILITARY VESSEL COMMERCIAL VESSEL HIGHWAY/RAIL VEHICLE PACKING DECLARATION,
10. VOYAGE DOCUMENT NUMBER AND 11. PORT/PLACE OF LOADING DD FORM 2781, IS ATTACHED
SAILING DATE (To be completed by the carrier) (X if applicable)

12. PORT/PLACE OF DISCHARGE 13. DESTINATION

14. SHIPPING DESCRIPTION OF GOODS (UN No., PSN, HC, SHC, PG, number and kind of package, and additional information NET MASS/QTY GROSS MASS
MARKS as required by regulation) (kg/l) (kg)

15. CONTAINER IDENTIFICATION NO./ 16. SEAL NUMBER(S) 17. CONTAINER/VEHICLE AND TYPE 18. TARE
VEHICLE REGISTRATION NO. MASS (kg)

19. ADDITIONAL HANDLING INFORMATION

20. RECEIVING ORGANIZATION RECEIPT

Received the above number of packages/containers/trailers in apparent good order and condition, unless stated hereon:
a. RECEIVING ORGANIZATION REMARKS

b. HAULER'S NAME c. VEHICLE REGISTRATION d. SIGNATURE AND DATE e. DRIVER'S SIGNATURE

NO.

21. SHIPPER PREPARING THIS FORM

SHIPPER'S DECLARATION. I hereby declare that the contents of this consignment are fully and accurately described above by the Proper Shipping Name,
and are classified, packaged, marked, and labeled/placarded and are in all respects in proper condition for transport according to the international and
national government regulations.
a. NAME OF COMPANY/MILITARY UNIT b. NAME/STATUS OF DECLARANT/CERTIFIER

c. PLACE AND DATE d. SIGNATURE OF DECLARANT/CERTIFIER

DD FORM 2890, OCT 2011 PREVIOUS EDITION IS OBSOLETE. Adobe Professional 8.0
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 INSTRUCTIONS FOR COMPLETING DD FORM 2890,
DOD MULTIMODAL DANGEROUS GOODS DECLARATION

Item 1. Shipper/Consignor/Sender. Enter the address and Item 14. Shipping Marks (Continued).
telephone number where the HAZMAT was certified. 7. Enter the total quantity of dangerous goods of each item
of HAZMAT bearing a different Proper Shipping Name, UN
Item 2. Transport Document Number (Ocean container shipments Number or Packing Group. For Class 1 material this quantity
only). The vessel manifest number to which the Multimodal
will be the net explosive mass/ weight (NEW) (number of
Dangerous Goods Declaration will be attached may be entered in this
block. The shipper need not enter this number. The accepting rounds shipped X NEW per round = net mass/weight/qty).
operator may enter it at the time it is assigned. Leave blank for Gross mass/weight is the total weight of the shipment
breakbulk shipments. Shipper enters container "V" number. including packaging and related items, e.g., dunnage. Net
mass is expressed in kilograms or liters, and gross mass in
Item 3. Page __ of __ Pages. Enter the page number and total kilograms.
number of pages. Example: Page 1 of 1. 8. Enter the gross weight of the shipment for each item of
HAZMAT bearing a different Proper Shipping Name, UN
Item 4. Shipper's Content Reference Number (TCN). Enter the Number or Packing Group.
17- character TCN.
Item 15. Container ID Number/Vehicle Registration
Item 5. Freight Forwarder's Reference. Leave blank.
Number. Enter ID number of the container or vehicle
Item 6. Consignee. Enter the six-digit DODAAC and/or the registration number. A dash (-) or blank space is acceptable
in-the-clear geographical location of the ultimate consignee (if known). before the check digit.
For shipments of infectious substances, enter also the full address,
name and telephone number of a responsible person for contact in an Item 16. Seal Number(s). Enter seal number installed on
emergency. container.

Item 7. Carrier. Enter Vessel Carrier Name. To be completed by the Item 17. Container/Vehicle and Type. Enter type and size
carrier. of container (20 or 40 ft.) or vehicle description (e.g.,
HUMVEE).
24 Hour Assistance Telephone Number(s). Circle applicable
emergency number(s).
Item 18. Tare Mass (kg). Enter tare weight of the
Item 8. Shipment Within the Limitations Prescribed for Military container.
Vessel/Commercial Vessel/Highway/Rail. Mark X in the
appropriate block. Item 19. Additional Handling Information. Optional.

Item 9. Container Certification/Vehicle Declaration. Declarant If applicable, provide additional handling instructions.
must mark X if applicable. U.S. Coast Guard or port officials may
require verification of the container certification/vehicle declaration. Enter the Emergency Response Guide (ERG) Number(s) of
DD Form 2781 is a detailed checklist which meets USCG/Customs the HAZMAT and attach the specific ERG page to DD Form
requirements. DD Form 2781 must be signed and attached to DD 2890.
Form 2890.

Item 10. Voyage Document Number and Sailing Date (To be If applicable, drivers transporting regulated HAZMAT on
completed by the carrier). Enter the voyage document number and European highways must be provided Transport Emergency
the date of sail. Cards (TREMCARDS) in the host nation language which
must be attached to the shipping papers.
Item 11. Port/Place of Loading. Enter the three-digit POE code
and/or the in-the-clear geographical location of the port of Item 20. Receiving Organization Receipt. Leave blank as
embarkation. this will be filled out by the receiving organization. Signing
this block states that the shipment is in good order, unless
Item 12. Port/Place of Discharge. Enter the three-digit POD code otherwise noted.
and/or the in-the-clear geographical location of the port of
debarkation.
Item 21. Shipper Preparing This Form.
Item 13. Destination (in the clear). Enter destination address.
a. Name of Company/Military Unit. Enter the name of
Item 14. Shipping Marks. company.
1. Enter the UN Number preceded by the letters "UN".
2. Enter the Proper Shipping Name. b. Name/Status of Declarant/Certifier. Enter the name and
3. Enter the primary hazard class and division number. For Class 1 status of the person signing the form.
material include the compatibility group letter. Any assigned
subsidiary hazard class or division will be entered following the c. Place and Date. Enter the place and date the material
primary class in parenthesis. was certified.
4. Enter the Packing Group when assigned.
5. Enter additional information from the IMDG, Chapter 5.4, as
required (i.e. Marine Pollutant, Flashpoint, Toxic Inhalation Hazard, d. Signature of Declarant/Certifier. The person who certifies
RQ, etc.). on behalf of DOD that the shipment complies with the
6. Enter the number and kind of packaging. applicable regulatory requirements must sign the form.

DD FORM 2890, OCT 2011