This form should be accompanied by either Form AP1 or Form FR1
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.
Leave blank if not yet registered.
1 Title number(s) of the property:
Insert address including postcode (if
any) or other description of the
property, for example ‘land adjoining
2 Acacia Avenue’.
2 Property:
3 Date:
Give full name(s).
Complete as appropriate where the
borrower is a company.
4 Borrower:
For UK incorporated companies/LLPs
Registered number of company or limited liability partnership
including any prefix:
For overseas companies
(a) Territory of incorporation:
(b) Registered number in the United Kingdom including any prefix:
Give full name(s).
Complete as appropriate where the
lender is a company. Also, for an
overseas company, unless an
arrangement with Land Registry
exists, lodge either a certificate in
Form 7 in Schedule 3 to the Land
Registration Rules 2003 or a certified
copy of the constitution in English or
Welsh, or other evidence permitted
by rule 183 of the Land Registration
Rules 2003.
5 Lender for entry in the register:
For UK incorporated companies/LLPs
Registered number of company or limited liability partnership
including any prefix:
For overseas companies
(a) Territory of incorporation:
(b) Registered number in the United Kingdom including any prefix:
Each proprieto
r
may give up to three
addresses for service, one of which
must be a postal address whether or
not in the UK (including the postcode,
if any). The others can be any
combination of a postal address, a
UK DX box number or an electronic
address.
6 Lender’s intended address(es) for service for entry in the register:
Place ‘X’ in any box that applies.
A
dd any modifications.
7 The borrower with
full title guarantee
limited title guarantee
charges the property by way of legal mortgage as security for the
payment of the sums detailed in panel 9
Place 'X' in the appropriate box(es).
You must set out the wording of the
restriction in full.
Standard forms of restriction are set
out in Schedule 4 to the Land
Registration Rules 2003.
8
The lender is under an obligation to make further advances
and applies for the obligation to be entered in the register
The borrower applies to enter the following standard form of
restriction in the proprietorship register of the registered
estate:
Insert details of the sums to be paid
(amount and dates) and so on.
9
A
dditional provisions
The borrower must execute this
charge as a deed using the space
opposite. If there is more than one
borrower, all must execute. Forms of
execution are given in Schedule 9 to
the Land Registration Rules 2003. If
a note of an obligation to make
further advances has been applied
for in panel 8 this document must be
signed by the lender or its
conveyancer.
10 Execution
WARNING
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 re
g
ister.
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 Re
g
istration Rules 2003.
© Crown copyright (ref: LR/HO) 10/11
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