For official use only
(1) Please insert name of
farmer, farmers or society.
Any additional names may be
set out on the back of this
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.
Signature of applicant of his solicitor Date
Applicant’s name and address
(2) This is the address to which the copy
memorandum will be sent.
(3) Please limit to 25 characters including oblique
strokes and punctuation.
Crown copyright (ref: LR/HQ) 02/11
Application for a
certified copy of the
memorandum filed in
the Register of
under the Act
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 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.
Agricultural Credits Department
2 William Prance Road
PLYMOUTH PL6 5WS
DX8249 PLYMOUTH 3