Certificate of conveyancer(s)
Date of registration
Particulars of the estate
Despatch of form
The following notes are supplied for assistance in making the application overleaf. Detailed
information for the making of all kinds of application 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
2. Please complete the form in block letters in writing or typewriting using black ink not
liable to smear. No covering letter is required.
3. Please give the name of the person on whose behalf the application is made. If the applicant
is not the person on whose behalf the registration was made, the application must be
(a) a release in writing of the home rights to which the charge relates, or
(b) the evidence referred to in paragraph 4(1) of Schedule 4 to the Family Law Act 1996
and, if the charge was registered or the registration of the charge was renewed pursuant
to s.33(5) of the said Act, evidence proving to the satisfaction of the Chief Land
Registrar that the order referred to in the application for registration or renewal has
ceased to have effect.
4. This certificate is only required where the application is signed by the person in whose
favour the registration was made and solicitors are acting on his/her behalf.
5. Complete all boxes and refer to month by three letters:
6. Please give the full name of the estate owner as entered on the register. Enter forenames and
surnames on separate lines.
7. 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.
8. Any reference should be limited to 25 characters (including oblique strokes and
9. The completed form should be despatched to the address below, which is printed in a
position to fit a standard window envelope.
Land Charges Department
Seaton Court, 2 William Prance Road,
PLYMOUTH PL6 5WS
DX 8249 PLYMOUTH (3)
Crown copyright (ref. LR/HO) 10/13