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 it attach 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.
1
Local authority serving the property:
2
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’.
Place ‘X’ in the appropriate box.
Give a brief description of the part
affected, for example ‘edged red on the
attached plan’.
Complete details of charge if appropriate.
3
Property:
The interest to be protected by the agreed notice affects
the whole of the registered estate
part of the registered estate as shown:
the registered charge dated in
favour of:
To find out more about our fees visit
www.gov.uk/government/collections/fees-
land-registry-guides
Place 'X' in the appropriate box.
The fee will be charged to the account
specified in panel 7.
4
Application and fee
Application
Fee paid (£)
Entry of agreed notice
Fee payment method
cheque made payable to 'Land Registry'
direct debit, under an agreement with Land Registry
List the documents lodged with this form.
If this application is accompanied by
either Form AP1 or FR1 please only
complete the corresponding panel on
Form AP1 or DL (if used). Original
documents are only required if your
application is a first registration, when we
will return the originals if a certified copy
has been supplied. If your application is
not a first registration then we only need
certified copies of deeds or documents
you send to us with HM 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.
5
Documents lodged with this form:
Provide the full name(s) of the person(s)
applying to enter the notice. Where a
conveyancer lodges the application, this
must be the name(s) of the client(s), not
the conveyancer.
6
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.
7
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:
Please state the interest to be noted.
For example, specify the date at the
beginning of the noted entry.
8
The applicant applies to enter an agreed notice protecting the
following interest:
The above interest is set out in [paragraph page of] the
document [numbered ] in [panel 5][Form AP1][Form DL].
If this is a variation of an interest that is already protected in the
register by a notice, please identify the notice:
You must place 'X' in only one box in this
panel.
List any supporting documents in panel 5
or on forms AP1 or DL (if used).
9
The applicant is entitled to apply for an agreed notice because
(A) Applicant is the registered proprietor
The applicant is the registered proprietor of the
estate/charge affected by the interest.
(B) Applicant is entitled to be registered as the proprietor
The applicant is the person entitled to be registered as the
proprietor of the estate/charge affected by the interest.
Evidence of such entitlement accompanies this application.
List any supporting documents in panel 5
or on forms AP1 or DL (if used).
List any supporting documents in panel 5
or on forms AP1 or DL (if used).
List any supporting documents in panel 5
or on forms AP1 or DL (if used).
(C) Consent of the registered proprietor or person entitled
to be registered as the proprietor is enclosed
The consent of the registered proprietor of the estate/charge
affected by the interest accompanies this application.
The consent of the registered proprietor of the estate/charge
affected by the interest is contained in panel 11 of this form.
The consent of the person entitled to be registered as the
proprietor of the estate/charge affected by the interest and
evidence of their entitlement to be so registered
accompanies this application.
The consent of the person entitled to be registered as
proprietor of the estate/charge affected by the interest is
contained in panel 11. Evidence that the person consenting
to this application is entitled to be registered as proprietor of
the registered estate/charge accompanies this application.
List any supporting documents in panel 5
or on forms AP1 or DL (if used).
(D) There is other evidence in support of the applicant's
claim
None of the above statements apply but evidence to
establish the validity of the applicant’s claim accompanies
this application.
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.
10
Signature of applicant
or their conveyancer:
Date:
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To be completed if referred to in the
box ticked in panel 9.
11
I/we consent to the entry of a notice in the register of the title(s)
specified in panel 2, to protect the interest specified in panel 8
Print full name
Signature
1.
1.
2.
2.
3.
3.
4.
4.
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.
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) 05/18
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