If you are paying by direct debit, this
will be the account charged.
This is the address to which we will
normally send requisitions. However
if you insert an email address, we will
use this whenever possible.
This application is sent to Land Registry by
Key number (if applicable):
Address or UK DX box number:
Insert the name of the cautioner as
shown on the register and if there are
two or more cautions in favour of the
same cautioner, please identify the
caution to which this application
relates by including the date at the
beginning of the caution entry and, if
that date is the same as that of one
of the other cautions, brief details of
The applicant applies for the caution identified below to be
Caution in favour of:
Date of caution entry, if appropriate:
Place 'X' in one box.
List the documents lodged with this
form.We only need certified copies of
deeds or documents you send to us
with Land Registry application forms.
Once we have made a copy of the
documents you send to us, they will
be destroyed, this applies to both
originals and certified copies.
Entitlement to apply
The applicant is the proprietor of the registered estate/charge
to which the caution relates
The applicant is, or but for the existence of the caution would
be, entitled to be registered as proprietor of the registered
estate/charge, and evidence of such entitlement is enclosed
as set out below:
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.
Under section 66 of the Land Registration Act 2002 most documents (including this form) kept by the registrar relating to an
application to the registrar or referred to in the register are open to public inspection and copying. If you believe a document
contains prejudicial information, you may apply for that part of the document to be made exempt using Form EX1, under rule 136
of the Land Registration Rules 2003.
© Crown copyright (ref: LR/HO) 06/14