ANNEX VII

Consignment information (1) 1. Person who arranges the shipment: Name: Address: Contact person: Tel.: Fax: E-mail: 2. Importer/consignee Name: Address: Contact person: Tel.: Fax: E-mail: 3. Actual quantity: kg: litre: 4. Actual date of shipment: 5 (a) (2) First carrier: Name: Address: Contact person: Tel.: Fax: E-mail: Means of transport: Date of transfer: Signature: 5 (b). Second carrier: Name: Address: Contact person: Tel.: Fax: E-mail: Means of transport: Date of transfer: Signature: 5 (c). Third carrier: Name: Address: Contact person: Tel.: Fax: E-mail: Means of transport: Date of transfer: Signature: 6. Waste generator (3) Original producer(s), new producer(s) or collector: Name: Address: Contact person: Tel.: Fax: E-mail: 8. Recovery operation (or if appropriate disposal operation in the case of waste referred to in Article 3(4)): R-code/D code: 9. Usual description of the waste: 7. Recovery facility Laboratory Name: Address: Contact person: Tel.: Fax: E-mail: 10. Waste identification (fill in relevant codes): (i) Basel Annex IX: (ii) OECD (if different from (i)): (iii) EC list of wastes: (iv) National code: 11. Countries/states concerned: Export/dispatch Transit Import/destination 12. Declaration of the person who arranges the shipment: I certify that the above information is complete and correct to my best knowledge. I also certify that effective written contractual obligations have been entered into with the consignee (not required in the case of waste referred to in Article 3(4)): Name: Date: Signature: 13. Signature upon receipt of the waste by the consignee: Name: Date: Signature: TO BE COMPLETED BY THE RECOVERY FACILITY OR BY THE LABORATORY: 14. Shipment received at recovery facility or laboratory Quantity received: kg: litre: Name: Date: Signature: (1) Information accompanying shipments of green listed waste and destined for recovery or waste destined for laboratory analysis pursuant to Regulation (EC) No 1013/2006. (2) If more than three carriers, attach information as required in blocks 5 (a), (b) and (c). (3) When the person who arranges the shipment is not the producer or collector, information about the producer or collector shall be provided.

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Source: EUR-Lex (Cellar) · retrieved 2026-10-29 · Text as adopted (Official Journal); later amendments are not incorporated in this text.