Any parts of the form that are not typed should be completed in black ink and in block capitals.
For information on how HM Land Registry processes your personal information, see our Personal Information
Use one form for each charge. You must supply two copies of the charge with this application.
Name of applicant:
Insert address(es) including postcode
(if any) of the applicant.
Phone no:
Email address:
Give full name(s),
Complete as appropriate where the
lender is a company. Also, for an
overseas company, unless an
arrangement with HM Land Registry
exists, lodge a certified copy of the
constitution in English or Welsh, or
other evidence permitted by rule 183
of the Land Registration Rules 2003.
A lender must give its legal name
exactly as registered in Companies
House or where the lender is a
foreign company within the meaning
of the Companies Act 2006 the full
legal name as registered in its state
of incorporation.
Lender for entry in the register:
For UK incorporated companies/I&PS
Companies House or I&PS registration number including any
prefix and or suffix:
For overseas companies
(a) Territory of incorporation:
(b) Registered number in England and Wales including the prefix
FC or BR as registered at Companies House:
Place 'X' in the box(es) if appropriate.
See Practice Guide 30 Approval of
mortgage documentation for a
definition of a standard restriction.
The charge contains a standard restriction in clause:
The charge contains an application for entry of an obligation
to make further advances in clause:
Each lender may give up to three
addresses for service, one of which
must be a postal address whether or
not in the UK (including the postcode,
if any). The others can be any
combination of a postal address, a
UK DX box number or an electronic
Once the charge has been approved,
we will only enter the address(es) for
service as given on this form on
registration of the charge. Any other
addresses given on an application to
register the approved charge will be
ignored. See the undertaking in panel
Lender’s intended address(es) for service for entry in the register:
Alterations to the approved form of
charge that are made in breach of the
undertaking may result in the
approval being withdrawn.
In respect of the draft charge deed for which approval is sought or
given the applicant undertakes
(i) to incorporate any amendments we have marked on the
approved charge. Approval is subject to the amendments
being made
(ii) not to alter the charge which has been approved and, where
elements of the final document are electronically stored, to
ensure that data is held securely and is not amended, without
the prior agreement of the Registrar, and
(iii) to notify Commercial Arrangements Section, HM Land
Registry Head Office at least two weeks prior to any alteration
of any of the address(es) for service of the lender given in
panel 5.
When completed this application
should be sent to:
HM Land Registry Head Office:
Commercial Arrangements Section
Trafalgar House
1 Bedford Park
Croydon CR0 2AQ
HM Land Registry Head Office
Commercial Arrangements Section
DX 8888
Croydon 3
The applicant warrants that the person signing this
application and undertaking has due authority to do so
Signed [on behalf of the lender]:
Applicant’s name:
UK DX box number:
Phone no:
Email address:
If you dishonestly enter information or make a statement that you know is, or might be, untrue or misleading, and intend by doing
so to make a gain for yourself or another person, or to cause loss or the risk of loss to another person, you may commit the
offence of fraud under section 1 of the Fraud Act 2006, the maximum penalty for which is 10 years’ imprisonment or an unlimited
fine, or both.
Failure to complete this form with proper care may result in a loss of protection under the Land Registration Act 2002 if, as a
result, a mistake is made in the register.
Under section 66 of the Land Registration Act 2002 most documents (including this form) kept by the registrar relating to an
application to the registrar or referred to in the register are open to public inspection and copying. If you believe a document
contains prejudicial information, you may apply for that part of the document to be made exempt using Form EX1, under rule 136
of the Land Registration Rules 2003.
For official use only
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