REC 1.79F
8/06
Page 1 of 2
North Carolina Real Estate Commission
P.O. Box 17100
Raleigh, N.C. 27619-7100
(919) 875-3700 • Fax (919) 877-4221 • www.ncrec.gov
DECLARATION OF AFFILIATION
BETWEEN A LIMITED NONRESIDENT COMMERCIAL REAL ESTATE LICENSEE
AND A RESIDENT BROKER
Pursuant to 21 NCAC 58A. 1807, no Limited Nonresident Commercial Real Estate Licensee shall enter North Carolina to perform any act
for which real estate licensing is required until such license enters into a Declaration of Affiliation and a Brokerage Cooperation Agreement
with a resident North Carolina real estate broker whose license is on active status. Execution of this form meets the requirements of 21
NCAC 58A. 1807(c). This form should NOT be filed with the North Carolina Real Estate Commission, but the nonresident licensee
and the resident broker should each retain a fully executed copy. In addition to completing this form and fulfilling its requirements, the
limited nonresident commercial licensee is subject to compliance with all other applicable laws of the State of North Carolina.
This Declaration of Affiliation shall be effective on the date of the last signature hereon and shall expire on ____________________ or the
expiration of any Brokerage Cooperation Agreement executed pursuant to this Declaration, whichever date is later.
DECLARATION OF LIMITED NONRESIDENT COMMERCIAL LICENSEE
By signing below, the limited nonresident commercial licensee acknowledges that he or she:
• Is affiliated with the North Carolina Resident Broker named in this Declaration below;
• Shall be bound by and subject to the provisions of the North Carolina Real Estate License Law and Commission
Rules when performing real estate brokerage acts in North Carolina;
• Shall pay to the North Carolina broker named herein any trust monies received by the nonresident commercial
licensee in connection with any transaction conducted under this Declaration of Affiliation for the North
Carolina broker to deposit in his or her firm’s trust account;
• Shall receive commissions, fees, or other compensation earned through his employing firm or broker;
• Shall maintain and retain all documents and records relating to transactions conducted under this Declaration
of Affiliation;
• Shall identify him or herself as a Limited Nonresident Commercial Real Estate Broker in all advertising in
connection with transactions conducted under this Declaration of Affiliation and any other advertising where
he or she holds him or herself out to be licensed in North Carolina; and
• Shall enter into a brokerage cooperation agreement or agreements as required by, and in accordance with, 21
NCAC 58A. 1807(b) in connection with any transaction(s) undertaken pursuant to this Declaration of
Affiliation.
FULL NAME:__________________________________________ N.C. LIC. # ____________________________
(Type or Print)
RESIDENCE ADDRESS: ______________________________________________________________________
FIRM NAME & ADDRESS: ____________________________________________________________________
(Primary Place of Business in Qualifying State)
PHONE: ______________________ FAX: ______________________ EMAIL: ___________________________
NONRESIDENT LICENSEE SIGNATURE: _______________________________________ DATE: __________
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