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.
I understand:
• 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.
SIGNED: ______________________________________________
NAME: _______________________________________________
DATE: ________________________________________________
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
®
, REALTORS
®
,
and the REALTOR
®
logo are controlled by The Canadian Real Estate Association (CREA) and identify
real estate professionals who are members of CREA.
