Formulaire Lithium

Formulaire déclaratif
Transport de piles et batteries au lithium
Declaration form
Transportation of lithium cells & batteries
Déclaration d’expéditeur Section II Piles et Batteries au Lithium
Shipper’s Declaration for Section II Lithium Cells / Batteries
왘 ATTENTION : les piles et batteries au lithium identifiées
par le fabricant comme étant défectueuses pour
des raisons de sécurité ou qui ont été endommagées
ne doivent pas être transportées par voie aérienne.
왘 WARNING: Lithium cells and batteries identified
by the manufacturer as being defective for safety
reasons, or that have been damaged must not
shipped air.
Détails de l’envoi / Shipment Details
N° LTA
——————————————————————————————————————————————————————
AWB number (for Direct Shipment)
Origine (optionnel)
—————————————————————————————————————
Origin (optional)
Destination (optionnel) ————————————————————————————————————————————————————————————————————————————————————————————————————
Destination (optional)
Informations expéditeur
Informations destinataire
Shipper’s Information
Consignee’s Information
Nom —————————————————————————————————————————————————————
Nom —————————————————————————————————————————————————————
Name
Name
Adresse —————————————————————————————————————————————————
Adresse —————————————————————————————————————————————————
Address
Address
—————————————————————————————————————————————————
—————————————————————————————————————————————————
Adresse —————————————————————————————————————————————————
Adresse —————————————————————————————————————————————————
N° téléphone
N° téléphone
—————————————————————————————————————————
Phone Number
—————————————————————————————————————————
Phone Number
CAUTION!
IF DAMAGED
Lithium ................... battery
DO NOT LOAD OR TRANSPORT
PACKAGE IF DAMAGED
For more information, call ...............................
Chronopost SAS
3 avenue Gallieni
94250 Gentilly, France
Service Client Entreprise
0825 801 801 (0,20 € TTC/mn)
chronopost.fr
SAS au capital de 32 632 000 € - 383 960 135 RCS Créteil
Prière de renseigner le numéro de téléphone
à contacter en cas d’urgence sur l’étiquette
ci-contre.
Please insert the emergency phone number on the sticker
on the left.
Formulaire déclaratif / Transport de piles et batteries au lithium
Declaration form / Transportation of lithium cells & batteries
N° envoi
Dépositaire
Shipment
Depositary
Nom / Name :
Signature :
Pour toutes autres informations, veuillez contacter l’expéditeur
For any further information, please contact the shipper:
Obligatoire / Mandatory
Expéditeur / Shipper
Destinataire / Consignee
Signature
Prénom / First Name
Nom / Last Name
Téléphone / Phone
(international format)
Adresse / Address
Information sur le contenu / Information about the content
Définitions
Definitions
• Pile : unité électromécanique capable de générer un courant électrique
• Batterie : assemblage de cellules
• Piles/batteries au lithium-ion : rechargeable et contient du lithiumpolymère
• Piles/batteries au lithium métal : généralement non-rechargeable
• Cell: electromechanical unit capable of generating electrical current
• Battery: assembly of cells
• Lithium ion cells / battery: rechargeable and includes lithium polymer
• Lithium metal cells / battery: generally non-rechargeable
Lithium ion
Lithium metal
Batteries contenues dans un équipement
Batteries contenues dans un équipement
Batteries contained in equipment
Batteries contained in equipment
UN 3481: Lithium ion batteries contained in
equipment not restricted as per section as per
Section II of IATA PI 967 (incl. lithium polymer batteries)
UN 3091: Lithium metal batteries contained in
equipment not restricted as per section as per
Section II of IATA PI 970 (incl. lithium alloy batteries)
Units Cells
Units Batteries
Units Cells
Units Batteries
[_]
[_]
[_]
[_]
[_]
[_]
[_]
[_]
Power rate ≤ 20 Wh
Power rate ≥ 20 Wh
Power rate ≤ 100 Wh
Power rate ≥ 100 Wh
Lithium ≤ 1 g
Lithium ≥ 1 g
Lithium ≤ 2 g
Lithium ≤ 2 g
Batteries emballées avec un équipement
Batteries emballées avec un équipement
Lithium ion batteries packed with equipment
Lithium ion batteries packed with equipment
UN 3481: Lithium ion batteries packed with
equipment not restricted as per section as per
Section II of IATA PI 966 (incl. lithium polymer batteries)
UN 3091: Lithium metal batteries packed with
equipment not restricted as per section as per
Section II of IATA PI 969 (incl. lithium alloy batteries)
Units Cells
Units Batteries
Units Cells
Units Batteries
[_]
[_]
[_]
[_]
[_]
[_]
[_]
[_]
Power rate ≤ 20 Wh
Power rate ≥ 20 Wh
Power rate ≤ 100 Wh
Power rate ≥ 100 Wh
Lithium ≤ 1 g
Lithium ≥ 1 g
Lithium ≤ 2 g
Lithium ≤ 2 g
Batteries emballées seules
Batteries emballées seules
Lithium ion batteries
Lithium ion batteries
UN 3480: Lithium ion batteries not restricted
as per section as per Section II of IATA PI 965
(incl. lithium ion polymer batteries)
UN 3090: Lithium metal batteries not restricted
as per section as per Section II of IATA PI 968
(incl. lithium alloy batteries)
INTERDIT / FORBIDDEN
INTERDIT / FORBIDDEN
왘 Quantité contenue dans le colis :
Quantity contained in the parcel:
[ __ ] Piles
[__] Cells
et / ou
and / or
[ __ ] Batteries
[__] Batteries
Informations obligatoires / Mandatory information
Le colis doit être manipulé avec soin / This package must be handled with care
Un risque d’inflammabilité existe si le colis est endommagé / A flammability hazard exists if the package is damaged
Des procédures spéciales qui doivent être suivies dans le cas où le colis serait endommagé / Special procedures
should be followed in the event the package is damaged including inspection and repacking if necessary