Important: Please read
the notes overleaf before
completing the form.
Form K12
Land Charges Act 1972
Fee panel
Place "X" in the appropriate box. See
Note 1 overleaf.
Application for cancellation of an entry in the
Register under special directions of The Registrar
Important: This form must not be used unless the registrar has first been
consulted and has approved its use.
A cheque or postal order for
the correct fee accompanies
this application.
Please debit our Direct Debit
under an authorised agreement
with Land Registry.
(See Notes 2 and 3 overleaf)
I/We hereby apply for cancellation in the register of the entry referred to below on behalf of
Full Name(s)
Exceptional hardship or expense would be caused if this application were made on form K11 because:
Signature Date
Address
Delete words
not applicable.
Land Charge (Class Sub-Class )
Annuity
Pending Action
Writ or Order
Deed of Arrangement
of the registration
Official reference no.
Date of registration
(See Note 4 overleaf)
Day
Month
Year
Only one individual or
body to be entered.
(See Note 5 overleaf)
Particulars of estate owner
For official use only
COUNTY
Forename(s)
Surname
Address
(See Note 6 overleaf)
Key Number
Conveyancer’s name and
address
(including postcode)
If no conveyancer is acting
enter applicant’s name and
address (including
postcode).
(See Notes 7 and 8 overleaf)
1
2
3
*C
4 5 6
Conveyancer’s reference:
Fee payable
Use of Form K12
Form completion
Date of registration
Particulars of the
estate owner
Key number
Conveyancer’s reference
Despatch of form
Explanatory Notes
The following notes are supplied for assistance in making the application overleaf. Detailed
information for the making of all kinds of applications to the Land Charges Department is
contained in Practice Guide 63 Land Charges Applications for registration, official search,
office copy and cancellation, which is obtainable on application at the address shown below.
1. Fees must be paid by Direct Debit under an authorised agreement with Land Registry or by
cheque or postal order made payable to “Land Registry” (see the Practice Guide referred to
above).
2. This form must not be used unless the Registrar has first been consulted and approved its use.
3. Please complete the form in block letters in writing or typewriting using black ink not liable to
smear. No covering letter is required and no plan or other supporting document should be sent
with the application.
4. Complete all boxes and refer to month by three letters eg:
Day
Month
Year
0
4
S
E
P
1
9
8
1
5. Please give the full name of the estate owner or debtor as currently entered on the register. Enter
forename(s) and surname on separate lines. The name of the company or other body should
commence on the forename line and may continue on the surname line (the words “Forename(s)
and “Surname” should be deleted).
6. If you have been allocated a key number, please take care to enter this in the space provided
overleaf, whether or not you are paying fees by Direct Debit.
7. Any reference should be limited to 25 characters (including oblique strokes and punctuation).
8. When completed, this application form should be despatched to the address shown below which
is printed in a position to fit within a standard window envelope.
The Superintendent
Land Charges Department
Registration Section
Seaton Court, 2 William Prance Road,
PLYMOUTH PL6 5WS
DX 8249 PLYMOUTH (3)
Crown copyright (ref: LR/HO) 10/13
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