Fill - Free fillable Land Registry - EX1 - Exempt information document PDF form

Use one form per document.

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.

HM Land Registry is unable to give legal advice, but you can find

guidance on HM Land Registry applications (including our practice

guides for conveyancers) at www.gov.uk/land-registry.

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 Charter.

HM LAND REGISTRY USE ONLY

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:

Leave blank if this application

accompanies an application for first

registration.

Title number(s) of the registered estate(s) to which the

document relates:

Insert address including postcode (if

any) or other description of the

property, for example ‘land adjoining

2 Acacia Avenue’.

Property:

Some register entries refer to

documents being filed under a

different title number.

Title number under which this document is held (if different from

that in panel 2):

To find out more about our fees visit

www.gov.uk/government/collections/f

ees-land-registry-guides

Place 'X' in the appropriate box.

The fee will be charged to the

account specified in panel 7.

Application and fee

Application

Fee paid (£)

Designation of a document as an

exempt information document

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 to designate the

document as exempt. Where a

conveyancer lodges the application,

this must be the name(s) of the

client(s), not the conveyancer.

The applicant:

This panel must always be

completed.

A key number is only available to

professional customers, such as

solicitors.

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.

We will only issue warning of

cancellation letters to conveyancers if

an email address is inserted.

This application is sent to Land Registry by

Key number (if applicable):

Name:

Address or UK DX box number:

Email address:

Reference:

Phone no:

Fax no:

Each applicant 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.

If we serve notice of an application

for an official copy of the document,

we shall serve it on the person whose

name appears in panel 6 at the

address given in this panel. If these

panels are not completed, we shall

serve notice on the person identified

in panel 7.

Applicant's address:

Include date, parties and nature of

document.

Provide details of the document that the applicant claims contains

prejudicial information:

Please note that a full, unedited

version of the document referred to in

panel 9 (which can be a certified

copy) must be lodged with this

application (or any accompanying

application) unless already filed at

HM Land Registry. Once we have

made a copy of the document you

sent us, it will be destroyed, this

applies to both the original or certified

copy documents.

Warning: Have you checked to make

sure that the prejudicial information

does not appear in any other

document which may be open to

inspection?

I enclose a copy of the document referred to in panel 9 that

excludes the prejudicial information

This copy is certified as being a true copy of the original from

which the prejudicial information has been excluded

I apply to the registrar to designate the document referred to in

panel 9 as an exempt information document

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:

Date:

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 register.

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