CompanyLetterhead(MUSTbeissuedbythepackerorsupplierofthegoodsandMUSTincludethecompany’snameANDaddress)FCLPACKINGDECLARATIONVesselName:…MOLCOSMOS…………VoyageNumber:…043W…………………Consignmentidentifierornumericallink……JGQD15084052PROHIBITEDPACKAGINGMATERIALSTATEMENT(Prohibitedpackagingmaterialsuchasstraw,bamboo,peat,hay,chaff,usedfruit&vegetablecartons)Q1Haveprohibitedpackagingmaterialsorbambooproductsbeenusedaspackagingordunnageintheconsignmentcoveredbythisdocument?A1YESNOTIMBERPACKAGING/DUNNAGESTATEMENT(Timberpackaging/dunnageincludes:crates,cases,pallets,skids,andanyothertimberusedasashippingaid.)Q2aHassolidtimberpackaging/dunnagebeenusedinconsignmentscoveredbythisdocument?A2aYESNOTREATMENTCERTIFICATION(ONLYIFTIMBER/DUNNAGEISDECLAREDINQUESTION2)Q3Alltimberpackaging/dunnageusedintheconsignmenthasbeen:(Pleaseindicatebelow.)TreatedandMarkedincompliancewithISPM15OrTreatedincompliancewithDAFFTreatmentRequirements(WithaccompanyingTreatmentCertificate)OrNotTreatedCONTAINERCLEANLINESSSTATEMENT(forFCL/Xconsignmentsonly-statementtoberemovedfromdocumentwhennotrelevant)Thecontainer(s)coveredbythisdocumenthas/havebeencleanedandis/arefreefrommaterialofanimaland/orplantoriginandsoil.Signed:............................................................(CompanyRepresentative)Dateofissue:....02/09/15......................................(DD/MM/YYYY)Printedname:......林鹏........................................