Please enable JavaScript in your browser to complete this form.Purpose of Disclosure Statement: Pursuant to Hawaii Revised Statutes, Chapter 508D (for residential real property), a seller of residential real property is obligated to fully and accurately disclose in writing to a buyer all “material facts” concerning the property. For all other real estate transactions, including the sale of vacant land, sellers are also advised to uphold any common law duty to disclose all material facts necessary to prevent misleading representations. "Material facts" are defined as "any fact, defect, or condition, past or present, that would be expected to measurably affect the value to a reasonable person of the residential real property being offered for sale." Pursuant to Hawaii Revised Statutes, Chapter 508D-8, this Disclosure Statement may exclude information regarding: (1) An occupant of the residential real property was afflicted with acquired immune deficiency syndrome (AIDS) or AIDS related complex, or had been tested for human immunodeficiency virus; or (2) The residential real property was the site of an act or occurrence that had no effect on the physical structure or the physical environment of the residential real property, or the improvements located on the residential real property”. This Disclosure Statement is intended to assist Seller in organizing and presenting all material facts concerning the Property. It is very important that Seller exercise due care in preparing responses to questions posed in the Disclosure Statement, and that all responses are made in good faith, are truthful and complete to the best of Seller's knowledge. Seller's agent, Buyer and Buyer's agent may rely upon Seller's disclosures. SELLER IS ENCOURAGED TO OBTAIN PROFESSIONAL ADVICE AND/OR HAVE AN EXPERT INSPECT PROPERTY PRIOR TO PREPARING THE DISCLOSURE STATEMENT. MUST BE COMPLETED BY SELLER ONLY Seller's Statement: This is a statement concerning information relating to the condition of Property that: (i) is within the knowledge or control of Seller; (ii) can be observed from visible, accessible areas; or (iii) which is required by Section 508D-4.5 and 508D-15, Hawaii Revised Statutes. Seller may not be aware of problems affecting Property, and there may be material facts of which Seller is not aware that qualified experts may be able to discover or time may reveal. Unless Buyer has been otherwise specifically advised, Seller has not conducted any inspections of generally inaccessible areas of Property. BUYER SHOULD TAKE CARE TO PROTECT BUYER'S OWN INTEREST BY OBTAINING PROFESSIONAL ADVICE AND BY CONDUCTING THOROUGH INSPECTIONS AND OBTAINING EXPERT HELP IN EVALUATING PROPERTY AND BY OBTAINING BUYER'S OWN PUBLIC RECORDS. THIS DISCLOSURE STATEMENT IS NOT A WARRANTY OF ANY KIND BY SELLER OR BY ANY AGENT REPRESENTING SELLER AND IS NOT A SUBSTITUTE FOR ANY EXPERT INSPECTION, PROFESSIONAL ADVICE, OR WARRANTY THAT BUYER MAY WISH TO OBTAIN. General Instructions to Seller: (1) Answer ALL questions in Sections A and B. (2) If Sections C, D, E, OR F apply to the subject property, even in part, that section shall be marked as applicable and the entire section must be filled out in its entirety. If sections C, D, E or F do not apply to the subject property, then that section should be marked with an NA. (3) If any items are checked or answered yes, explain all material facts known to you. (4) All structures must be covered in the Disclosure Statement. Each separate structure shall be addressed by separate Disclosure Statement. (5) NTMK means NOT TO MY KNOWLEDGE. (6) NA means NOT APPLICABLE and cannot be answered by “Yes”, “No”, or “NTMK”. Basic InformationSeller Name *Email *Phone *Your Home Address *Where you currently reside.Second Seller on Title? *YESNOSecond Seller Name *Second Seller Email *Your Agent's Name *Your Agent's Email *Your Agent's Brokerage *Property For Sale AddressTMK *Property Type? *CONDOSINGLE FAMILYLANDTENURE *Fee SimpleLeaseholdDo you presently Occupy property for sale? *YESNODate of Last Visit?Has the property ever been rented during your term of ownership? *YESNOName of Property Manager(s): *If you managed rentals yourself Enter 'Self Managed'Do any of the following conditions exist? 1) Is the property subject to Covenants, Conditions and Restrictions (CC&Rs)? *YESNONTMKNAPlease Explain *1a) Are there any violations of the Covenants, Conditions and Restrictions covering the property? *YESNONTMKNAPlease Explain 1a) *2) Is the property currently used for transient accommodations? *YESNONTMKNAPlease Explain 2) *2a) Does the property have a license for transient accommodations? *YESNONTMKNAIf yes, please provide documents.Please Explain 2a) *2a) Do you have document to Upload?YESNOFile Upload Click or drag files to this area to upload. You can upload up to 7 files. Please locate these Documents, they will be needed to close Escrow. 2b) If yes, are there any periodic re-licensing requirements? *YESNONTMKNAPlease Explain 2b) *2c) Are you aware of any violations past or present of the license or regulations? *YESNONTMKNAPlease Explain 2c) *2d) Has the property previously been used for transient accommodations? *YESNONTMKNAPlease Explain 2d) *3) Is the property subject to any recorded or unrecorded land lease? *YESNONTMKNAe.g. Pasture lease, Sandwich leasePlease Explain 3) *3a) If yes, are there any violations of the land leases? *YESNONTMKNAPlease Explain 3a) *4) Is the property located in a Special Management Area? *YESNONTMKNAPlease Explain 4) *4a) Is Property Oceanfront? *YESNONTMKNA4a) If oceanfront property, are there any past and existing State Shoreline Certification? *YESNONTMKNA If yes, Shoreline Certification will be need to close Escrow.Please Explain 4a) *Do you have State Shoreline Certification to Upload? *YESNOFile Upload Click or drag a file to this area to upload. Please locate these Documents, they will be needed to close Escrow. 5) Is the property located in a tsunami evacuation zone? *YESNONTMKNAPlease explain 5) *6) Is the property located in volcanic hazard Zone 1 or 2? *YESNONTMKNAWhat Lava Zone? *Zone 1Zone 27) Is the property subject to air pollution? *YESNONTMKNAPlease explain 7) *8) Is the property located in a geothermal subzone or near a geothermal facility? *YESNONTMKNAPlease explain 8) *9) Is the property located in the regular path of aircraft and does it experience regular excessive aircraft noise? *YESNONTMKNAPlease explain 9) *10) Is the property located within the boundaries of the Air Installation Compatibility Use Zone (restricted air space) of any Air Force, Army, Navy, or Marine Corps airport as officially designated by military authorities? *YESNONTMKNAPlease explain 10) *11) Are you aware of the presence of or removal of unexploded military ordinance in this general area? *YESNONTMKNAPlease explain 11) *12) Is the property located in a Special Flood Hazard Area, as officially designated on flood maps promulgated by the National Flood Insurance Program of the Federal Emergency Management Agency for the purposes of determining eligibility for emergency flood insurance programs? *YESNONTMKNAPlease explain 12) *12a) Does the property have a Pre-Flood Insurance Rate Map structure built before the following: *YESNONTMKNAPlease explain 12a) *12b) Is there an Elevation Certificate? *YESNONTMKNA12b) Do you have Elevation Certificate to Upload?YESNOElevation Certificate File Upload Click or drag files to this area to upload. You can upload up to 3 files. Please locate these Documents, they will be needed to close Escrow. 12c) Has the property ever received Federal Disaster Funds? *YESNONTMKNAPlease Explain 12c)13) Does the property lie within the sea level rise exposure area designated by the Hawai`i Climate Change Mitigation and Adaptation Commission? *YESNONTMKNAPlease Explain 13)14) Are there any easements affecting the property? *YESNONTMKNAPlease Explain 14)15) Are there any roadways, driveways, walls, fences, and/or other improvements which are shared with adjoining land owners? *YESNONTMKNAPlease Explain 15)16) Are there any known encroachments? *YESNONTMKNAPlease Explain 16)17) Are there any written agreements concerning items 14, 15, or 16? *YESNONTMKNAPlease Explain 17)17a) Do you have these documents to upload? *YESNODocuments Upload Click or drag a file to this area to upload. PDF Format Only.Please locate these Documents, they will be needed to close Escrow. 18) Is access to the property restricted? *YESNONTMKNA18a) How is access to the property restricted? *NTMK Private Road By EasementOther18A) Please explain Restriction *19) Are there any violations of government regulations/ordinances related to the property? *YESNONTMKNAPlease explain 19) *20) Are there any zoning or setback violations and/or citations? *YESNONTMKNAPlease explain 20) *21) Are there any restrictions on rebuilding? *YESNONTMKNAPlease explain 21) *22) Are there any nonconforming uses or unpermitted structures on the property? *YESNONTMKNAPlease explain 22) *23) Is the property exposed to other types of recurring excessive noise? *YESNONTMKNAe.g., night club, school, street traffic, animals, coqui frogs.Please explain *24) Are there any additional material facts as defined above regarding the property? *YESNONTMKNAe.g., pesticides, soil problems, irrigation, odors, pending development in the area, road widening projects, zoning changes, rail, etc.Please explain *25) Are there any other additional material facts related to the property concerning historic registers, Hawaii's Historic Preservation Program, archaeological surveys or historic features? *YESNONTMKNAPlease explain *26) Is there any existing or past damage to the property or any of the structures (interior or exterior) from earthquake, fire, smoke, flooding, leaks, landslides, falling rocks, tsunami, volcanic activity, or wind? *YESNONTMKNAPlease explain *27) Are there any additional material facts regarding the neighborhood that would be expected to measurably affect the value of the property? *YESNONTMKNAPlease explain *28) Have there ever been substances, materials, or products known to be an environmental or health hazard such as, but not limited to, asbestos, formaldehyde, by-products of methamphetamine manufacturing, radon gas, lead-based paint, fuel or chemical storage tanks, contaminated soil or water? *YESNONTMKNAPlease explain *29) Is there filled land on the property? *YESNONTMKNAPlease explain *Filled land location? *30) Has there ever been any settling or slippage, sliding, subsidence, or other soil problem? *YESNONTMKNAPlease explain *31) Has there ever been any drainage, water infiltration, seepage, flooding, or grading problems? *YESNONTMKNA32) Is there any damage caused by tree roots to/from the property or to/from another adjoining property? *YESNONTMKNAPlease explain *33) Were additions, modifications, and/or alterations made to the property without obtaining required approvals? *YESNONTMKNAPlease explain *34) Does any other party have an unrecorded interest in the property and/or a say in its disposition? *YESNONTMKNA35) Are there any lawsuits or foreclosure actions affecting the property? *YESNONTMKNAPlease explain *36) Did you purchase the property as a foreclosure? *YESNONTMKNA36a) Judicial or Non-Judicial? *JudicialNon-JudicialUtilitiesU1) What is the source of water supply?CatchmentPublicPrivateNAOtherCatchment Tank TypeCatchment Tank CapacityCatchment Tank AgeCatchment Tank ConditionOther Water SourceIs the property separately metered? YESNOIs there a sub-meter?YESNONASub meters for water are used to measure or record the amount of water used by a tenant within a multi-tenant property.Is there a shared water supply?YESNOU2) What type of waste water/sewage system does the property have?Public SewerPrivate Individual Sewage Treatment PlantCesspoolSeptic TankNAU2l) LocationWhen was it last Pumped?U2a) How often Pumped?U2a) Did any Cesspool or Septic System pumping/overflow generate a report to any Government Agency?YESNOU2b) Was there a Fine?YESNOU2ab) Does the cesspool serve more than one dwelling or living unit (A “dwelling” or, “living unit” is defined as having its own kitchen/food preparation area, bathroom and sleeping/living area), including “ohana” units?YESNOU2ac) Is there any Abandoned septic systems or cesspools? *YESNOU2ac) Is Abandoned Septic System(s) or Cesspool(s) Filled In? *YESNONTMKU2ad) Abandoned septic or cesspool Location * Individual Sewage Treatment Plant Vendor?U2a) Is Sewer Connected?YESNOU2b) Is Sewer Connection Required?YESNOU2c) Is there a seperate Sewer Fee?YESNOWhat is Sewer Fee? *U3) What is the source of electrical power?PublicPhotovoltaic OtherNAU3o) Please explain "Other" *U3a) Is the property subject to Special Subdivision Project Provision (SSPP) connection fees?YESNOU3b) Do you pay the electrical utility bill directly?YESNOIf yes, please state the amount you paid for electricity for the most recent three-month period that the property was occupied. 1st Month Date1st Month Amount2nd Month Date2nd Month Amount3rd Month Date3rd Month AmountU3c) If Seller's interest in a photovoltaic system is included in the sale, answer the following * LeasedFinancedOwned OutrightOtheri.e. leases/finance agreements, service/maintenance agreements, utility agreements net metering/buyback and/or credit agreements, user manuals, battery maintenance and warranties. U3cOther) Please explain "Other" *U3d) Do you have Photovoltaic Documents ready to Upload? *YESNOPlease locate these Documents, they will be needed to close Escrow. Photovoltaic File(s) Upload Click or drag files to this area to upload. You can upload up to 7 files. PDF format Only.U3e) If there is a photovoltaic system, does it contain an energy storage system, such as batteries? *YESNOU4) Is a Solar Hot Water System is included with the sale? *YESNOU4a) Is Solar Hot Water System *LeasedFinanced Owned outright i.e. lease/financing agreement, service/maintenance agreements, user manualsU3d) Do you have Solar Hot Water Documents ready to Upload? *YESNOYear Solar Hot Water Heater Installed? *Please locate these Documents, they will be needed to close Escrow. Solar Hot Water Documents File Upload * Click or drag files to this area to upload. You can upload up to 7 files. PDF Format ONLY.U5) Is a Security Alarm and/or Home Automation System is included with the sale *YESNOU5a) Is Security Alarm and/or Home Automation System *LeasedFinancedOwned OutrightU5a) Do you have Alarm System Documents ready to Upload? *YESNOPlease locate these Documents, they will be needed to close Escrow. Solar Alarm System Documents File Upload * Click or drag files to this area to upload. You can upload up to 7 files. PDF Format ONLY.U6) Gas *PipedTank (Propane)NoneNAU7) Telephone *TraditionalCableCellSatelliteNAU8) Television Service *AntennaCableSatelliteNAU9) Internet *DSLCableOtherNAPlease explain "Other" *U10) US Postal Delivery * PO Box Community/Cluster Individual Curbside BoxOtherU10o) Please explain "Other" *ASSOCIATIONSC) Is there a Homeowner AssociationYESNONTMKNAC1) Name of Homeowner's Association (HOA)/Community Association (CA) Management Firm(s) *C1p) Phone *C2) Is membership mandatory? *YESNONTMKC3) HOA/CA fee(s)Price: $ 0.00C3f) HOA/CA Fee Frequency *MonthlyQuarterlyBi-AnnualYearlyC3a) What is included in the fee(s) *CableCommon Area MaintenanceElectricityInternetInsuranceLandscape MaintenancePest controlPoolsProperty ManagementReserve FundsRoad MaintenanceRoofsSewerSubstructureTrashWaterNAOtherPlease Explain "Other" *C4) Are you are aware of future maintenance fee increases, special assessments, association loans or pending litigation for or against the Association?YESNONTMKPlease Explain *C5) Are there any “common area” facilities co-owned in undivided interest with others?YESNONTMKSuch as pools, tennis courts, walkways, driveways, or other areasPlease Explain *CONDO SPECIFICD) Condo Project Name *D1) Name of Association of Apartment/Unit Owners (AOAO/AOUO) Management Firm *D1p) Phone *D2) Is membership mandatory? *YESNONTMKD3) AOAO/AOUO fee(s) and payment frequency? *MonthlyQuarterlyBi-AnnualD3a) What is included in the fee(s) *CableCommon Area MaintenanceElectricityInternetInsuranceLandscape MaintenancePest controlPoolsProperty ManagementReserve FundsRoad MaintenanceRoofsSewerSubstructureTrashWaterOtherPlease explain "Other" *D4) Are you are aware of future maintenance fee increases, special assessments, association loans or pending litigation for or against the Association?YESNONTMKD5) Are there any “common area” facilities co-owned in undivided interest with others? *YESNONTMKSuch as pools, tennis courts, walkways, driveways, or other areasD6) Are there any restrictions/prohibitions imposed upon pet ownership? *YESNONTMKPlease Explain *D7) Are the developer of the CPR (Condominium Property Regime)? *YESNOD7a) Have you sold one or more of the properties in the CPR? *YESNOD7b) If yes, what is the expiration date of the Public Report? *D8) Does this unit include parking? *YESNONTMKNAD8a)How Many? *d8bStall Number(s) *D8c)Parking Assigned or Un-Assigned *AssignedUn-assignedD8d) Parking Stall Type *CoveredPartialUncoveredPrivate GarageCarportStandardCompactTandemD8e) Is Parking/Stall deeded with the unit? *YESNONTMKNAD8f) Are there any issues or special arrangements with the parking stall(s)? *YESNONTMKNAD8fe) Please Explain *D9) Does the unit include any storage unit(s), boat dock(s), or anything additional? *YESNONTMKNAPlease Explain *D9a) Is it deeded with the unit? *YESNONTMKNAD10) Has there been any damage to the unit due to leakage or water intrusion from above or adjacent to the unit, or damage caused by leakage or water intrusion from the unit to areas or space below the unit? *YESNONTMKNAPlease Explain *D11) Are you aware of any defects to the common or limited common elements affecting the unit? *YESNONTMKNAPlease Explain *E. IMPROVEMENTS:Defined as a any changes to a dwelling on the property; additions, alterations, modifications, structural or otherwise in/on property/etc. Please Answer the following questionsE1) Do any improvements, additions, structural modifications or alterations exist at the property without required building permits, association design committee or other governmental approvals? *YESNONTMKNAE1a) Please Explain *E2) Were any improvements, additions, structural modifications or alterations built/made with building permits, association design committee or other governmental approvals? *YESNONTMKNAPlease Explain *E2a) For any improvement(s) subject to a mechanic's and materialman's lien, has Notice of Completion been published? *YESNONTMKNADo you know Date of Publication *YESNONTMKNAE2ad) Date of Publication *E2c) Were any of the building permits not finalized (closed) by the permitting agency? *YESNONTMKNAPlease Explain *E2d) Were any of the improvements to the property built under an owner-builder permit? *YESNONTMKNAPlease Explain *Date of Final Inspection Approval by the County: *E3) Was any electrical or plumbing work done without a licensed electrician or plumber? *YESNONTMKNAPlease Explain *E4) Is the Seller/Builder a licensed contractor who is providing warranties? *YESNONTMKNAPlease Explain *E5) Have you given any release or waiver of liability, or release from a warranty to any government agency, contractor, engineer, architect, land surveyor, or landscape architect, for any defect, mistake, or omission in the design or construction of the Property? *YESNONTMKNAPlease Explain *E6) Is the property sprinklered for fire protection? *YESNONTMKNAPlease Explain *E7) Is the property equipped with smoke/carbon monoxide detectors? *YESNONTMKNAHow Many? *E7a) Are they wired into the electrical system?Wired into the Electrical SystemBattery PoweredNTMKE8) What is the age of the main roof *E8a) Has the roof beenReplacedRepairedTreatedNTMKNAPlease Explain *Date of Repair, Modification or Treatment? *E9) Has there been any evidence or presence of mold, mildew and/or fungus interior or exterior?YESNONTMKNAE9y) Please Explain *E10) Has there been any evidence of pest infestation?YESNONTMKNAe.g., roaches, fleas, bedbugs, mites, ticks, ants, rats, centipedes, etc.Please Explain *E11) Has there been any evidence or presence of wood destroying organisms in the improvements?YESNONTMKNAe.g. termites, powder post beetles, dry rot, carpenter ants/bees, etc.Please Explain *E11a) Is there any known damage to the improvements caused by wood destroying organisms?YESNONTMKNAPlease Explain *E11b) Has the damage been repaired?YESNONTMKNAPlease Explain *E12) Are there any transferable warranties ?YESNONTMKNAeg. Appliances, pest treatment, roof, photovoltaic, otherF. DEFECTS, REPAIRS OR REPLACEMENTSF1) Are you aware of any past or present defects, repairs or replacements, check items listed below? *F1) Air Conditioning F2) AppliancesF3) Bathtubs/ShowersF4) CeilingsF5) Ceiling FansF6) Central Vacuum SystemsF7) Counters/CabinetsF8) Decking/Railings/LanaiF9) DoorbellsF10) Doors (all types)F11) DrivewaysF12) Electrical Systems Switches, etcF13) Electronic Controls/RemotesF14) Fences/Walls/GatesF15) Fire Sprinkler SystemF16) Fireplace/ChimneyF17) Floors/Floor CoveringsF18) Foundations/SlabsF19) GuttersF20) Heating SystemsF21) Lawn Sprinkler SystemF22) Lighting FixturesF23) Plumbing - ExteriorF24) Plumbing - InteriorF25) Roofs/Eaves/SkylightsF26) Security SystemsF27) Sinks/FaucetsF28) Smoke Detectors/AlarmF29) Solar Water SystemsF30) Solar/Photovoltaic SystemsF31) Spa/Hot Tub/SaunaF32) Swimming PoolF33) ToiletsF34) Ventilation SystemsF35) Walkways/Sidewalksf36) Walls Exterior/Trimf37) Walls Interior/Baseboards/Trimf38) Water Featuresf39) Water Heaterf40) Window Coverings/Awningsf41) Windows/ScreensF42) OtherNoneF1) Please Explain Air Conditoning *F2) Please Explain Appliances *F3) Please Explain Bathtubs/Showers *F4) Please Explain Ceilings *F5) Please Explain Ceiling Fans *F6) Please Explain Central Vacuum Systems *F7) Please Explain Counters/Cabinets *F8) Please Explain Counters/Cabinets *F9) Please Explain Doorbells *F10) Please Explain Doors (all types) *F11) Please Explain Driveways *F12) Please Explain Electrical Systems Switches, etc *F13) Please Explain Electronic Controls/Remotes *F14) Please Explain Fences/Walls/Gates *F15) Please Explain Fire Sprinkler System *F16) Please Explain Fireplace/Chimney *F17) Please Explain Floors/Floor Coverings *F18) Please Explain Foundations/Slabs *F19) Please Explain Gutters *F20) Please Explain Heating Systems *F20) Please Explain Heating Systems (copy) *F21) Please Explain Lawn Sprinkler System *F22) Please Explain Lighting Fixtures *F23) Please Explain Plumbing - Exterior *F24) Please Explain Plumbing - Interior *F24) Please Explain Other *F25) Please Explain F25 *F26) Please Explain F26) Security Systems *F27) Please Explain F27) Sinks/Faucets *F28) Please Explain F28) Smoke Detectors/Alarm *F29) Please Explain F29) Solar Water Systems *Is property within a 3.2 ft Sea Level Rise Exposure Area? *YESNONTMKI attest that I am the Legal Seller of this Property *YESNOSeller SignatureBy Completing and Signing this document, I attest the information is accurate to the best of my knowledge. Signature *Clear Signature Submit SRPDS
