Application for registration
in farmer’s name
HM Land Registry
• Please complete the white boxes in typescript or BLOCK LETTERS using
black ink that will not smear. No covering letter is required and the instrument
creating the charge should not be enclosed with the application.
• A registration fee is payable in respect of the name of each farmer entered on this
form. Fees must be paid by credit account or by cheque or Postal Order, made
payable to “HM Land Registry”.
• The address panel below is printed in a position so as to fit within a standard
window envelope.
(1) Please insert name and
address of bank applying.
(2) A branch manager or
solicitor to the bank may sign
on behalf of the bank.
(3) Registration must be
effected within 7 working
days of the date of the
instrument. See sec. 9(1) of
the Act.
(4) For definition of “farmer”
see sec. 5(7) of the Act.
(5) If more than one name,
the additional name(s) and
address(es) should be set out
on the back of this form.
(6) If the charge is to secure a
current or loan account or
other undetermined sum this
should be set out here.
(7) Please state whether the
charge is a fixed or floating
charge or both.
(8) For definition of “bank”
see sec. 5(7) of the Act.
(9) Please limit to 25
characters including oblique
strokes and punctuation.
The
(1)
of
applies for the registration of this memorandum of an instrument in writing creating an agricultural
charge under the above Act, short particulars of which are given in the schedule below.
(2)
Signature of applicant on behalf of bank Date
Schedule of particulars
Date of Instrument
(3)
Name(s) and address(es) of farmer(s) whose stock and other assets are affected
(4)
Forename(s)
(5)
Surname(s)
Address (including county)
Sum secured by the charge
(6)
£
The charge is a
(7)
charge
Name and address of bank
(8)
in whose favour the memorandum of charge is registered
Name
Address
I consent to the above application
Signature of farmer Date
Key Number
Applicant’s name and address
(including postcode)
For official use only
1
#
2
3
4
5
6
Applicant’s
reference
(9)
Telephone
Number
Crown copyright (ref: LR/HQ) 02/11
This margin must be left clear
For official use only
Official number
The Superintendent
Agricultural Credits Department
Seaton Court
2 William Prance Road
PLYMOUTH PL6 5WS
DX8249 PLYMOUTH 3
AC1
(Agricultural Credits Act 1928)
