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For official use only
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(1) Please insert name of
farmer, farmers or society.
Any additional names may be
set out on the back of this
form.
I/We apply for a certified copy of the memorandum filed in the Register of Agricultural Charges
under the Act against the following name(s) on the
under reference no.
Forename(s)
(1)
Surname
Forename(s)
Surname
Signature of applicant of his solicitor Date
Key Number
Applicant’s name and address
(including postcode)
(2)
(2) This is the address to which the copy
memorandum will be sent.
(3) Please limit to 25 characters including oblique
strokes and punctuation.
Applicant’s
reference
(3)
Telephone
Number
Crown copyright (ref: LR/HQ) 02/11
Application for a
certified copy of the
memorandum filed in
the Register of
Agricultural Charges
under the Act
HM Land Registry
AC5
(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 required.
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.
The Superintendent
Agricultural Credits Department
Seaton Court
2 William Prance Road
PLYMOUTH PL6 5WS
DX8249 PLYMOUTH 3
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