Operator Date of Occurrence Local Time of Occurrence Flight Date Flight No. Departure Airport Destination Airport Aircraft Type Aircraft Registration Location of Occurrence Origin of the Goods Description of the Occurrence, Including Details of Injury, Damage, etc. (If Necessary, Continue on the Reverse of This Form) Proper Shipping Name (Including the Technical Name) UN/ID No (When Known) Class/Division (When Known) Subsidiary Risk(s) Packing Group Category (Class 7 Only) Type of Packaging Packaging Specification Marking No. of Packages Quantity (or Transport Index, if Applicable) Reference No of Air Waybill Reference No of Courier Pouch, Baggage Tag, or Passenger Ticket Name and Address of Shipper, Agent, Passenger, etc. Other Relevant Information (Including Suspected Cause, Any Action Taken) Name and Title of Person Making Report Telephone No Company Reporter's Ref Address Signature Date Description of the Occurrence (Continuation) CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
