Australian Capital Territory
Agent/Salesperson Disclosure Notice Approval 2003
Approved form AF2003-26
made under the 
Agents Act 2003, s 177 

1	Name of instrument
	This instrument is the Agent/Salesperson Disclosure Notice Approval 2003.
2	Commencement 
	This instrument commences on the day after notification.
3	Approval
	The attached form is approved.

Elizabeth Kelly
Commissioner for Fair Trading 
24 October 2003 

Agents Act 2003 – Form 1 (AF2003-26)

agent/salesperson DISCLOSURE NOTICE 

TO: [Insert name and address of recipient of the form]

Your sale/purchase of [insert address of property]

I/we* set out below:

•	The nature of my/our* relationship with each person named below to whom I/we* have referred you for professional services associated with the sale or purchase;
•	The amount or value of the monetary or other benefit which I/we* derive or expect to derive from each person.

Name of person	Nature of relationship	Amount or value of
		benefit

1.
2.
3.
4.
5.
6.

[If insufficient space, add an annexure]

I/we* also set out below, so far as I/we* know, the amount, value or nature of any benefit any person has received, receives, or expects to receive in connection with the sale/purchase*, or for promoting the sale/purchase*, or for providing a service in connection with the sale/purchase*, of the land.

Name of person	Capacity	Amount, value or nature of
	any benefit

1.
2.
3.
4.
5.
6.

[If insufficient space, add an annexure]

……………………………………….
(Signature of seller’s/buyer’s* agent)

……………………………………….
[Print name of seller’s buyer’s* agent and the agent’s licence or registration number]

DATED: