Estate Agents Authority

(address)

  I (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , holder of estate agent's licence number: (3) . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . hereby give you notice that I became/ceased to be* a member of (4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on (5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . (D/M/Y) which does or will do estate agency work.

Note:

Please file this Notice with the Estate Agents Authority before the expiration of the period of 31 days beginning on the date of the cessation.