Any parts of the form that are not typed should be completed in
black ink and in block capitals.
If you need more room than is provided for in a panel, and your
software allows, you can expand any panel in the form. Alternatively
use continuation sheet CS and attach it to this form.
HM Land Registry is unable to give legal advice, but you can find
guidance on HM Land Registry applications (including our practice
guides for conveyancers) at www.gov.uk/land-registry.
Conveyancer is a term used in this form. It is defined in rule 217A,
Land Registration Rules 2003 and includes persons authorised
under the Legal Services Act 2007 to provide reserved legal services
relating to land registration and includes solicitors and licensed
conveyancers.
For information on how HM Land Registry processes your personal
information, see our Personal Information Charter.
HM LAND REGISTRY USE ONLY
Record of fees paid
Particulars of under/over payments
Reference number
Fees debited £
Where there is more than one local
authority serving an area, enter the
one to which council tax or
business rates are normally paid.
1
Local authority serving the property:
2
Title number(s) of property:
Insert address including postcode
(if any) or other description of the
property, for example ‘land
adjoining 2 Acacia Avenue’.
Place 'X' in the appropriate box.
3
Property:
The application relates to
the whole of the title(s)
Give a description by reference to
an attached plan enabling the land
to be identified on the Ordnance
Survey map.
part of the title(s) as shown:
To find out more about our fees
visit
www.gov.uk/government/collections
/fees-land-registry-guides
Place 'X' in the appropriate box.
The fee will be charged to the
account specified in panel 7.
4
Application and fee
Application
Fee paid (£)
Registration of a person to be
notified of an application for
adverse possession
Fee payment method
cheque made payable to 'Land Registry'
direct debit, under an agreement with Land Registry
Provide the full name(s) of the
person(s) making this application.
Where a conveyancer lodges the
application, this must be the
name(s) of the client(s), not the
conveyancer.
5
The applicant:
Each applicant 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 address.
6
Applicant's intended address(es) for service (including postcode)
for entry in the register:
This panel must always be
completed.
A key number is only available to
professional customers, such as
solicitors.
If you are paying by direct debit,
this will be the account charged.
This is the address to which we will
normally send requisitions and
return documents. However if you
insert an email address, we will use
this whenever possible.
We will only issue warning of
cancellation letters to conveyancers
if an email address is inserted.
7
This application is sent to Land Registry by
Key number (if applicable):
Name:
Address or UK DX box number:
Email address:
Reference:
Phone no:
Fax no:
Place 'X' in the appropriate box.
8
Confirmation of interest and application
I/We confirm that the applicant has an interest in the
registered estate
registered rentcharge
being the title as entered in panel 2 which would be prejudiced by
the registration of any other person as proprietor of that
estate/rentcharge under Schedule 6 to the Land Registration Act
2002. The applicant hereby applies to the registrar to be registered
as a person or persons to be notified of any application under
paragraph 1 of Schedule 6 to the Land Registration Act 2002.
Place 'X' in the appropriate box.
9
Identity of person making the statement of truth in panel 10
The statement is made by (one of) the applicant(s).
The full name of the person making the statement is:
The statement is made on behalf (one of) of the applicant(s),
who cannot make this statement for the following reasons:
The full name of the person making the statement is:
Address:
The statement is made by a conveyancer acting for the
applicant(s).
The conveyancer's full name is:
Firm name (if any):
Address or UK DX box number:
This panel must set out the nature
of the applicant's interest. Do not
attach any documents.
See the warnings at the end of this
form.
If a joint statement is made by two
or more persons, consequential
amendments can be made to the
text in this panel (for example, ‘I’
can be changed to ‘we’).
If the person making the statement
is unable to sign it, this wording will
need to be amended to comply with
rule 215A(5) and (6) of the Land
Registration Rules 2003. In
addition, and in cases where the
person making the statement is
unable to read, there will need to be
an appropriate certificate: see rule
215A(4) and (5).
10
Statement of truth
I state that the applicant is interested in the property described in
panel 3 as:
I believe that the facts and matters contained in this statement are
true.
Signature:
Print full name:
Date:
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signature
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If a conveyancer is acting for the
applicant, that conveyancer must
sign. If no conveyancer is acting, the
applicant (and if more than one
person then each of them) must sign.
11
Signature of applicant
or their conveyancer:
Date:
WARNING
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.
© Crown copyright (ref: LR/HO) 05/18
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signature
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