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.

***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.