Use one form per document.
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 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 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:
Leave blank if this application
accompanies an application for first
Title number(s) of the registered estate(s) to which the document
Insert address including postcode (if
any) or other description of the
property, for example ‘land adjoining
2 Acacia Avenue’.
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):
See fees calculator at
Place 'X' in the appropriate box.
The fee will be charged to the
account specified in panel 7.
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 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:
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:
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
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
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
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
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:
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.
© Crown copyright (ref: LR/HO) 06/14