Coronavirus Statement and Consent
Based on my (the undersigned’s) actual knowledge, personal awareness and belief, the undersigned hereby
states that he/she:
Does not currently have any symptoms associated with COVID-19.
Has not been exposed to anyone with symptoms associated with COVID-19 within the last 14 days.
Has not travelled outside of Canada within the last 14 days.
I consent to the collection, use and disclosure of the foregoing information solely for the purpose of:
(a) determining whether to permit the viewing of a property for sale or rent; or (b) informing my broker
(or representative) or, where I am not represented, the undersigned directly, about any coronavirus-related
developments in connection with the property that I wish to view.
• Any afﬁrmative answer may result in my inability to view a property for sale or rent.
• This information will not be disclosed to anyone other than the seller and/or the seller’s or the buyer’s
broker (or representative thereof) unless with my consent or as permitted or required by law.
• The seller’s broker (or representative thereof) may contact my broker (or representative thereof) or the
undersigned directly, where I am not represented, for the purpose of informing me in the event any
person living in the viewed property is determined to have been exposed to COVID-19.
• If I am diagnosed with COVID-19 within 14 days of my viewing of the property for sale or rent, I shall
immediately contact my broker (or representative thereof) to advise them and that they may inform
the seller’s broker (or representative thereof) and/or the seller of such diagnosis. Where I am not
represented I shall inform the seller’s broker (or representative thereof) or seller directly.
PHONE NUMBER: _____________________________________
EMAIL ADDRESS: _____________________________________
BUYER’S BROKER (or representative thereof):
This form has been prepared by The Canadian Real Estate Association to assist REALTORS
in light of the
COVID-19 pandemic. Where forms have been prepared in the REALTORS
’ jurisdiction by their regulator,
Board, or Association, such forms should be used instead. The trademarks REALTOR
and the REALTOR
logo are controlled by The Canadian Real Estate Association (CREA) and identify
real estate professionals who are members of CREA.