Victorian Consolidated Regulations

Introduction Agents Regulations 1998 - SCHEDULE 3

ACKNOWLEDGEMENT OF WARNING Introduction Agents Act 1997 Section
33(1)(b)-Acknowledgement of Warning
I,                                                        of

(Name of potential client) (Address) acknowledge that I have received from
(Name of introduction agent) ("the agent") a warning that there is no
reasonable chance that the provision of an introduction service by him/her/it
to me will result in me obtaining the introductions that I am seeking. I
understand that if I choose to enter into an introduction agreement with the
agent, I am allowed to withdraw from the agreement at any time, provided that
I give the agent a written notice signed by me that states that I am
withdrawing from the agreement. I also understand that, if I exercise my right
to withdraw from the agreement, the agent is entitled to: (1) all money paid
or due under the agreement up to the time that he/she/it receives my
withdrawal notice; and (2) $50 or 10% of the total that is to be paid to
him/her/it under the agreement (whichever is the lower amount). Apart from
these amounts, I will not be liable to the agent in any way for withdrawing
from the agreement. Signed:
(Potential Client) Dated: __________________