ANNEX VII
Information Accompanying Shipments of Waste 
as referred to in Article 3 (2) and (4)
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:  Tonnes (Mg):                    m3:
	4. Actual date of shipment:	
5.(a) First carrier (2)
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) Annex IIIA (4):
(iv) Annex IIIB (5):
(v) EC list of wastes:
(vi) National code:
(vii) Other (please specify):	
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:	Tonnes (Mg): 	m3:

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. For completing this document, see also the corresponding specific instructions as contained in Annex IC of Regulation (EC) No 1013/2006 on shipments of waste
(2)	If more than 3 carriers, attach information as required in blocks 5 (a, b, c).
(3)	When the person who arranges the shipment is not the producer or collector, information about the producer or collector shall be provided.
(4)	The relevant code(s) as indicated in Annex IIIA to Regulation (EC) No 1013/2006 are to be used, as appropriate in sequence. Certain Basel entries such as  B1100, B3010 and B3020 are restricted to particular waste streams only, as indicated in Annex IIIA.
(5)	The BEU codes listed in Annex IIIB to Regulation (EC) No 1013/2006 are to be used.