"I CERTIFY THAT THIS CARGO DOES NOT CONTAIN ANY UNAUTHORIZED EXPLOSIVES, INCENDIARIES OR HAZARDOUS MATERIALS. I CONSENT TO A SEARCH OF THIS CARGO. I AM AWARE THAT THIS ENDORSEMENT AND ORIGINAL SIGNATURE, ALONG WITH OTHER SHIPPING DOCUMENTS, WILL BE RETAINED ON FILE FOR AT LEAST THIRTY DAYS."

SHIPPER'S/COMPANY NAME:	DATE:

SIGNATURE OF SHIPPER OR AUTHORIZED REPRESENTATIVE:

PRINT/TYPE NAME OF INDIVIDUAL WHOSE SIGNATURE APPEARS AS SHIPPER OF AUTHORIZED REPRESENTATIVE

TYPE OF FIRST PERSONAL IDENTIFICATION REVIEWED:
MATCHING PHOTO OF ID?	YES	NO
NUMBER APPEARING ON ID

TYPE OF SECOND PERSONAL IDENTIFICATION REVIEWED (IF THE FIRST WAS NOT A GOVERNMENT ISSUED PHOTO ID):
MATCHING PHOTO ON ID? INDICATE:	YES	NO
NUMBER APPEARING ON ID

NAME OF PERSONA FROM WHOM SHIPMENT WAS ACCEPTED IF DIFFERENT FROM THE SHIPPER

*THIS DOCUMENT IS MANDATORY AND MUST ACCOMPANY EACH AND EVERY SHIPMENT*