(the “Property”)
The Brokerage will provide assistance to the Landlord or Seller as a self-represented party for the lease of the above
described Property, to a tenant client and the
Landlord acknowledges and consents to the terms as stated in this Form.

The Landlord hereby represents and warrants that the Property is not listed or posted for lease or for sale with any other
registered
real estate brokerage and that the Landlord or Seller has the sole and exclusive authority to execute this
Form.
[sign* Landlords/SellersInitials]

1. DEFINITIONS AND INTERPRETATIONS: (For the purposes of this Form:)
“Landlord” includes lessor, Seller includes owner and “Tenant” includes a lessee, or a prospective lessee. “Self-represented
assistance” shall mean assistance provided to a
self-represented party. A lease shall be deemed to include the entering into of any rental / sale agreement,
sub-lease or renewal of a lease. For purposes of
this Form, anyone introduced to or shown the Property shall be deemed to include any spouse, heirs,
executors, administrators, successors, assigns,
related corporations and affiliated corporations. Related corporations or affiliated corporations shall
include any corporation where one half or a
majority of the shareholders, directors or officers of the related or affiliated corporation are the same
person(s) as the shareholders, directors, or officers
of the corporation introduced to or shown the Property. Commission shall be deemed to include other
remuneration. This Form shall be read with all
changes of gender or number required by the context

2. REPRESENTATION AND ASSISTANCE TO A SELF-REPRESENTED PARTY
The Landlord / Seller acknowledges that the Brokerage has provided the
Landlord with written information explaining relationships, including information on Landlord
Representation, Sub-Agency, Tenant Representation,
Multiple Representation and Self-Represented Party assistance. The Landlord / Seller acknowledges that the Brokerage
will be providing assistance to the
Landlord / seller, as a service to a tenant / buyer client, and will not be representing the interests of the Landlord or Seller in a
transaction.
The Brokerage may or will be providing services and representing the interests of a tenant / buyer client in any
transaction. When the Brokerage is representing a
tenant / buyer as a client, the Brokerage’s primary duties are to protect and promote the interests of the tenant / buyer
client. The Brokerage will disclose all pertinent
information to a tenant client obtained from or about the Landlord / seller.
Even though the Brokerage’s primary duties may be to a tenant or buyer, the Brokerage may provide assistance to the
Self-Represented Party Landlord or seller. When
providing assistance to the Self-Represented Parties, the Brokerage assistance includes:

• The Ethical duty to deal fairly, honestly and with integrity
• The Legal duty to exercise due care when answering questions and providing information
• The Legal duty to avoid misrepresentation.

The Landlord / seller understands and acknowledges that the Brokerage also provides representation to other landlords
/ sellers and tenants and potential assistance
to other self-represented party landlords and tenants.
If the Brokerage represents or provides self-represented assistance to more than one landlord, seller or tenant for
the same trade, the Brokerage shall, in
writing, at the earliest practicable opportunity and prior to any offer being submitted or conveyed, inform
all landlords and tenants of the nature of
the Brokerage’s relationship to each party.

3. PROFESSIONAL ADVICE: The Landlord / seller acknowledges the Brokerage has recommended to
seek independent professional advice and
any information provided by the Brokerage to any party is not to be relied upon as legal, tax,
environmental or other advice. The Landlord is not
to rely on the Broker’s or Salesperson’s skill or judgment in respect of a trade in real estate.

4. FINDERS FEES: The Landlord acknowledges that the Brokerage may be receiving a finder’s fee,
reward and/or referral incentive, and the Landlord
consents to any such benefit being received and retained by the Brokerage in addition to any commission
payable.

5. INDEMNIFICATION AND INSURANCE: : The Landlord / seller will not hold the Brokerage and
representatives of the Brokerage responsible for any loss
or damage to the Property or contents occurring and caused by the Brokerage or anyone else by any means,
including theft, fire or vandalism, other
than by the Brokerage’s gross negligence or willful act. The Landlord / seller will indemnify and save harmless the
Brokerage and representatives of the
Brokerage from any liability, claim, loss, cost, damage or injury, including but not limited to loss of any
commission payable, caused or contributed to
by the breach of any warranty or representation made by the Landlord / seller in this Form. The Landlord / seller warrants the
Property is insured, including personal
liability insurance against any claims or lawsuits resulting from bodily injury or Property damage to others
caused in any way on or at the Property
and the Landlord indemnifies the Brokerage and all of its employees, representatives, salespersons and
brokers for and against any claims against
the Brokerage made by anyone who attends or visits the Property.

INITIALS OF BROKERAGE:

INITIALS OF LANDLORD/Seller(S):


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7. USE AND DISTRIBUTION OF INFORMATION: The Landlord / Seller consents to the collection, use and
disclosure of personal information by the
Brokerage for the purpose of compiling, retaining and publishing any statistics including data which may be
used by the Brokerage to conduct
comparative market analyses; and make such other use of information as the Brokerage deems appropriate in
connection with the listing, marketing,
selling or leasing of real estate

8. FAMILY LAW ACT: The Landlord / seller hereby warrants that spousal consent is not necessary under
the provisions of the Family Law Act, R.S.O. 1990,
unless the spouse of the Landlord has executed the consent hereinafter provided.

9. CONFLICT OR DISCREPANCY If there is any conflict or discrepancy between any provision added
to this Form (including any Schedule attached
hereto) and any provision in the standard pre-set portion hereof, the added provision shall supersede the
standard pre-set provision to the extent of such
conflict or discrepancy. This Form, including any Schedule attached hereto, shall constitute the entire Form
between the Landlord and the Brokerage.
There is no representation, warranty, collateral agreement or condition, which affects this Form other than
as expressed herein.

10. ELECTRONIC COMMUNICATION: This Form and any agreements, notices or other communications
contemplated thereby may be transmitted
by means of electronic systems, in which case signatures shall be deemed to be original. The transmission of
this Form by the Landlord by electronic
means shall be deemed to confirm the Landlord / seller has retained a true copy of the Form.

11. ELECTRONIC SIGNATURES: : If this Form has been signed with an electronic signature the
parties hereto consent to the use of such electronic
signature with respect to this Form, and any other documents contemplated by this Form, pursuant to the
Electronic Commerce Act, 2000, S.O. 2000,
c17 as amended from time to time

LEASED SIGN: The Landlord / seller hereby consents by initialing this term of the Form
that, upon the Landlord / Seller
entering into a binding Agreement to lease the Property with a tenant client of the brokerage, the Brokerage
is authorized to
place the Brokerage’s leased sign on the Property.


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SCHEDULE(S) attached hereto form(s) part of this Form.

THIS FORM HAS BEEN READ AND FULLY UNDERSTOOD BY ME, I ACKNOWLEDGE AND CONSENT TO THE TERMS OF THIS
FORM AND
ON THIS DATE I HAVE SIGNED UNDER SEAL.
SIGNED, SEALED AND DELIVERED I have hereunto set my hand and seal:

THIS FORM HAS BEEN READ AND FULLY UNDERSTOOD BY ME, I ACKNOWLEDGE AND CONSENT TO THE TERMS OF THIS
FORM AND
ON THIS DATE I HAVE SIGNED UNDER SEAL.
SIGNED, SEALED AND DELIVERED I have hereunto set my hand and seal:
(Signature of Landlord or seller)


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(Date)

(Tel. No.)

(Signature of Landlord or seller)


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(Date)

(Tel. No.)

SPOUSAL CONSENT: The undersigned spouse of the Landlord hereby consents to the lease of the
Property herein pursuant to the provisions of the Family
Law Act, R.S.O. 1990 and hereby agrees to execute all necessary or incidental documents to further any
transaction provided for herein.

(Spouse)

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(Date)

(Tel. No.)