Fee payable
Use of Form K12
Form completion
Date of registration
Particulars of the
estate owner
Key number
Conveyancer’s reference
Despatch of form
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:
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
