This form should be accompanied by either Form AP1 or Form FR1.
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.
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
Provide the full name(s) of the person(s)
applying for entry of the notice. Where a
conveyancer lodges the application, this
must be the name(s) of the client(s), not
The applicant applies for an entry to be made in the register of
the titles listed in panels 3 and 4 below to show that the charges
The original or a certified copy of this
charge must be lodged unless the
charge is registered.
Date of charge in which the right to consolidate is reserved:
Title number(s), if registered:
Name of lender:
Charges consolidated with the charge referred to in panel 3
The original or a certified copy of the
charge(s) must be lodged unless the
charge is registered. If two or more
charges of the same property of even
date are listed, include a number or
other identifier for each charge in the
I certify that the charge identified in panel 3 reserves a right of
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.
Signature of applicant
or their conveyancer:
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.
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