DOS-1736-f (Rev. 11/15) Page 1 of 2
New York State
Department of State
Division of Licensing Services
P.O. Box 22001
Albany, NY 12201-2001
Customer Service: (518) 474-4429
www.dos.ny.gov
New York State Disclosure Form for Buyer and Seller
THIS IS NOT A CONTRACT
New York State law requires real estate licensees who are
acting as agents of buyers or sellers of property to advise
the potential buyers or sellers with whom they work of the
nature of their agency relationship and the rights and
obligations it creates. This disclosure will help you to make
informed choices about your relationship with the real estate
broker and its sales agents.
Throughout the transaction you may receive more than
one disclosure form. The law may require each agent
assisting in the transaction to present you with this
disclosure form. A real estate agent is a person qualified to
advise about real estate.
If you need legal, tax or other advice, consult with a
professional in that field.
Disclosure Regarding Real Estate
Agency Relationships
Seller’s Agent
A seller’s agent is an agent who is engaged by a seller to
represent the seller’s interests. The seller’s agent does this
by securing a buyer for the seller’s home at a price and on
terms acceptable to the seller. A seller’s agent has, without
limitation, the following fiduciary duties to the seller:
reasonable care, undivided loyalty, confidentiality, full
disclosure, obedience and duty to account. A seller’s agent
does not represent the interests of the buyer. The obligations
of a seller’s agent are also subject to any specific provisions
set forth in an agreement between the agent and the seller.
In dealings with the buyer, a seller’s agent should (a)
exercise reasonable skill and care in performance of the
agent’s duties; (b) deal honestly, fairly and in good faith; and
(c) disclose all facts known to the agent materially affecting
the value or desirability of property, except as otherwise
provided by law.
Buyer’s Agent
A buyer’s agent is an agent who is engaged by a buyer to
represent the buyer’s interest. The buyer’s agent does
this by negotiating the purchase of a home at a pric
e and
on terms acceptable to the buyer. A buyer’s agent has,
without limitation, the following fiduciary duties to the
buyer: reasonable care, undivided loyalty,
confidentiality, full disclosure, obedience and duty to
account. A buyer’s agent does not represent the interest of
the seller. The obligations of a buyer’s agent are also
subject to any specific provisions set forth in an agreement
between the agent and the buyer. In dealings with the
seller, a buyer’s agent should (a) exercise reasonable
skill and care in performance of the
agent’s duties; (b) deal honestly, fairly and in good faith; and
(c) disclose all facts known to the agent materially affecting
the buyer’s ability and/or willingness to perform a contract to
acquire seller’s property that are not consistent with the
agent’s fiduciary duties to the buyer.
Broker’s Agents
A broker’s agent is an agent that cooperates or is engaged
by a listing agent or a buyer’s agent (but does not work for
the same firm as the listing agent or buyer’s agent) to assist
the listing agent or buyer’s agent in locating a property to sell
or buy, respectively, for the listing agent’s seller or the buyer
agent’s buyer. The broker’s agent does not have a direct
relationship with the buyer or seller and the buyer or seller
cannot provide instructions or direction directly to the
broker’s agent. The buyer and the seller therefore do not
have vicarious liability for the acts of the broker’s agent. The
listing agent or buyer’s agent do provide direction and
instruction to the broker’s agent and therefore the listing
agent or buyer’s agent will have liability for the acts of the
broker’s agent.
Dual Agent
A real estate broker may represent both the buyer and the
seller if both the buyer and seller give their informed consent
in writing. In such a dual agency situation, the agent will not
be able to provide the full range of fiduciary duties to the
buyer and seller. The obligations of an agent are also
subject to any specific provisions set forth in an agreement
between the agent, and the buyer and seller. An agent
acting as a dual agent must explain carefully to both the
buyer and seller that the agent is acting for the other party as
well. The agent should also explain the possible effects of
dual representation, including that by consenting to the dual
agency relationship the buyer and seller are giving up their
right to undivided loyalty. A buyer or seller should carefully
consider the possible consequences of a dual agency
relationship before agreeing to such representation. A seller
or buyer may provide advance informed consent to dual
agency by indicating the same on this form.
Dual Agent with Designated Sales Agents
If the buyer and seller provide their informed consent in
writing, the principals and the real estate broker who
represents both parties as a dual agent may designate a
sales agent to represent the buyer and another sales agent
to represent the seller. A sales agent works under the
supervision of the real estate broker. With the informed
consent of the buyer and the seller in writing, the designated
sales agent for the buyer will function as the buyer’s agent
representing the interests of and advocating on behalf of the
buyer and the designated sales agent for the seller will
New York State Disclosure Form for Buyer and Seller
DOS-1736-f (Rev. 11/15) Page 2 of 2
function as the seller’s agent representing the interests of
and advocating on behalf of the seller in the negotiations
between the buyer and seller. A designated sales agent
cannot provide the full range of fiduciary duties to the
landlord or tenant. A designated sales agent cannot provide
full range of fiduciary duties to the buyer or seller. The
designated sales agent must explain that like the dual agent
under whose supervision they function, they cannot provide
undivided loyalty. A buyer or seller should carefully consider
the possible consequences of a dual agency relationship
with designated sales agents before agreeing to such
representation. A seller or buyer provide advance informed
consent to dual agency with designated sales agents by
indicating the same on this form.
This form was provided to me by of
(Print Name of Licensee) (Print Name of Company, Firm or Brokerage)
a licensed real estate broker acting in the interest of the:
Seller as a (check relationship below) Buyer as a (check relationship below)
Seller’s Agent Buyer’s Agent
Broker’s Agent Broker’s Agent
Dual Agent
Dual Agent with Designated Sales Agent
For advance informed consent to either dual agency or dual agency with designated sales agents complete section below:
Advance Informed Consent Dual Agency
Advance Informed Consent to Dual Agency with Designated Sales Agents
If dual agent with designated sales agents is indicated above: is appointed to represent the
buyer; and is appointed to represent the seller in this transaction.
(I) (We) acknowledge receipt of a copy of this disclosure form:
Signature of Buyer(s) and/or Seller(s):
Date: Date:
New York State
Department of State, Division of Licensing Services
(518) 474-4429
www.dos.ny.gov
New York State
Division of Consumer Rights
(888) 392-3644
New York State Housing Discrimination Disclosure Form
Federal, State and local Fair Housing Laws provide comprehensive protections from discrimination in
housing. It is unlawful for any property owner, landlord, property manager or other person who sells, rents or
leases housing, to discriminate based on certain protected characteristics, which include, but are not limited
to race, creed, color, national origin, sexual orientation, gender identity or expression, military status,
sex, age, disability, marital status, lawful source of income or familial status. Real estate professionals
must also comply with all Fair Housing Laws.
Real estate brokers and real estate salespersons, and their employees and agents violate the Law if they:
• Discriminate based on any protected characteristic when negotiating a sale, rental or lease,
including representing that a property is not available when it is available.
• Negotiate discriminatory terms of sale, rental or lease, such as stating a different price because of race,
national origin or other protected characteristic.
Discriminate based on any protected characteristic because it is the preference of a seller or landlord.
Discriminate by “steering” which occurs when a real estate professional guides prospective buyers or
renters towards or away from certain neighborhoods, locations or buildings, based on any protected
characteristic.
Discriminate by “blockbusting” which occurs when a real estate professional represents that a change has
occurred or may occur in future in the composition of a block, neighborhood or area, with respect to any
protected characteristics, and that the change will lead to undesirable consequences for that area, such
as lower property values, increase in crime, or decline in the quality of schools.
Discriminate by pressuring a client or employee to violate the Law.
Express any discrimination because of any protected characteristic by any statement, publication,
advertisement, application, inquiry or any Fair Housing Law record.
YOU HAVE THE RIGHT TO FILE A COMPLAINT
If you believe you have been the victim of housing discrimination you should file a complaint with the
New York State Division of Human Rights (DHR). Complaints may be filed by:
Downloading a complaint form from the DHR website: www.dhr.ny.gov;
Stop by a DHR office in person, or contact one of the Division’s offices, by telephone or by mail, to obtain
a complaint form and/or other assistance in filing a complaint. A list of office locations is available online at:
https://dhr.ny.gov/contact-us, and the Fair Housing HOTLINE at (844)-862-8703.
You may also file a complaint with the NYS Department of State, Division of Licensing Services. Complaints
may be filed by:
Downloading a complaint form from the Department of State’s website
https://www.dos.ny.gov/licensing/complaint_links.html
Stop by a Department’s office in person, or contact one of the Department’s offices, by telephone or by
mail, to obtain a complaint form.
Call the Department at (518) 474-4429.
There is no fee charged to you for these services. It is unlawful for anyone to retaliate against you for filing a complaint.
DOS-2156 (04/20) Page 1 of 2
New York State
Department of State, Division of Licensing Services
(518) 474-4429
www.dos.ny.gov
New York State
Division of Consumer Rights
(888) 392-3644
New York State Housing Discrimination Disclosure Form
For more information on Fair Housing Act rights and responsibilities please visit
https://dhr.ny.gov/fairhousing and https://www.dos.ny.gov/licensing/fairhousing.html.
This form was provided to me by (print name of Real Estate Salesperson/
Broker) of (print name of Real Estate company, firm or brokerage)
(I)(We)
(Real Estate Consumer/Seller/Landlord) acknowledge receipt of a copy of this disclosure form:
Real Estate Consumer/Seller/Landlord Signature Date:
Real Estate broker and real estate salespersons are required by New York State law to provide you with this Disclosure.
DOS-2156 (04/20) Page 2 of 2