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.
Land Registry is unable to give legal advice but our website
www.landregistry.gov.uk provides guidance on Land Registry
applications. This includes public guides and practice guides (aimed
at conveyancers) that can also be obtained from any Land Registry
See www.landregistry.gov.uk/contact-us/offices if you are unsure
which Land Registry office to send this application to.
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
Record of fees paid
Particulars of under/over payments
Reference number
Fees debited £
Where there is more than one local
authority serving an area, enter the
one to which council tax or business
rates are normally paid.
Local authority serving the property:
Insert address including postcode (if
any) or other description of the
property, for example ‘land adjoining 2
Acacia Avenue’.
Place 'X' in the appropriate box. Only
use the second option where the
property has an address and is fenced
on the ground.
Enter reference, for example 'edged
The extent of the land to which the caution relates can be clearly
identified on the current edition of the Ordnance Survey map from
the attached plan and shown:
the address shown in panel 2
See fees calculator at
Place 'X' in the appropriate box.
The fee will be charged to the account
specified in panel 6.
Application and fee
Fee paid (£)
Fee payment method
cheque made payable to 'Land Registry'
direct debit, under an agreement with Land Registry
Provide the full name(s) of the
person(s) applying for the caution.
Where a conveyancer lodges the
application, this must be the name(s)
of the client(s), not the conveyancer.
Complete as appropriate where the
cautioner is a company.
The cautioner:
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:
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:
Email address:
Phone no:
Fax no:
Place 'X' in the appropriate box(es)
and complete as necessary. In the
case of a leasehold estate,
rentcharge, franchise or profit a
prendre in gross, please provide full
details of the particular leasehold
estate, rentcharge, franchise or profit
affected. Include the date, nature and
parties of the instrument by which the
estate was created, if known; the
amount of the rentcharge; the nature
of the franchise or profit; and length of
the term, if leasehold.
If 'Yes', include all particulars for the
discontinued term, for example
affected days, weeks, months and so
The estate to which the caution relates is
the freehold
a lease dated for a term of
from made between
Is the lease discontinuous? Yes No
a rentcharge
a franchise
a profit a prendre in gross
Each cautioner 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
The address(es) for service for each cautioner to be entered in
the register is:
Place 'X' in the appropriate box.
This is for cases where the cautioner
is a company or firm, or is otherwise
incapable of making the statement
Insert reasons and describe the
relationship of the person making the
statement to the person on whose
behalf it is made. Enclose any
relevant documentation.
Identity of person making the statement of truth in panel 10
The statement is made by (one of) the cautioner(s).
The full name of the person making the statement is:
The statement is made on behalf of (one of) the cautioner(s),
who cannot make this statement for the following reasons:
The full name of the person making the statement is:
The statement is made by a conveyancer acting for the
The conveyancer’s full name is:
Firm name (if any):
Address or UK DX box number:
This panel must set out the nature of
the cautioner's interest. Do not attach
any documents.
See the warnings at the end of this
If a joint statement is made by two or
more persons, consequential
amendments can be made to the text
in this panel (for example, ‘I’ can be
changed to ‘we’).
If the person making the statement is
unable to sign it, this wording will
need to be amended to comply with
rule 215A(5) and (6) of the Land
Registration Rules 2003. In addition,
and in cases where the person
making the statement is unable to
read, there will need to be an
appropriate certificate: see rule
215A(4) and (5).
Statement of truth
I state that the cautioner is interested in the estate referred to in
panel 7 as:
I believe that the facts and matters contained in this statement are
Print full name:
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:
I/We consent to the lodging of the caution
Caution applications do not require
any consents. However, a person may
consent to the lodging of a caution in
accordance with rule 47 of the Land
Registration Rules 2003. By so
consenting that person may only
apply to cancel the caution under
section 18(1) of the Land Registration
Act 2002 if one of the exceptions
under rule 46 of the Land Registration
Rules 2003 applies.
Print full name(s)
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