(1) Please insert name of
farmer, farmers or society.
Where there are two or more
farmers entered on the
Register continue on the back
of this form.
I/We apply for a certificate that the registration of an
Agricultural Charge which was registered at the Land Registry
against the following name or names has been cancelled.
Date of registration
Signature of Applicant or his solicitor Date
It is certified that the above registration has been cancelled.
under Reference No.
Applicant’s name and address
(2) This is the address to
which the official
certificate will be sent.
(3) Please limit to 25
characters including oblique
strokes and punctuation.
Crown copyright (ref: LR/HQ) 02/11
a certificate that
a registration has
HM Land Registry
(Agricultural Credits Act 1928)
• Please complete the white boxes in typescript or
BLOCK LETTERS using black ink that will not
smear. No covering letter is necessary.
• 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.
For official use only
Agricultural Credits Department
2 William Prance Road
PLYMOUTH PL6 5WS
DX8249 PLYMOUTH 3