Page 1 of 2 RQ (Revised 3/14)
Please send the completed form by post to:
Citizen Centre (RQ)
Land Registry Wales Office
Tŷ Cwm Tawe
Phoenix Way
Llansamlet
Swansea
SA7 9FQ
DX No: 82800 Swansea (2)
You can also send this form by email to rq-request@landregistry.gsi.gov.uk. If you choose to send this by email
please be aware that the information we receive from you over the internet is not encrypted and may not be
completely secure.
The restriction set out in section 4 is designed to help prevent forgery. It does so by requiring that a
conveyancer certify they are satisfied that the person transferring or mortgaging the property is the same
person as the owner.
Provide the contact
address(es) of the
individual(s) requesting the
entry of the restriction. Where
a conveyancer lodges this
form, these details must be
those of the client(s), not
those of the conveyancer.
The restriction will not
normally be entered in
response to this request if
the only contact address
supplied is the address of
the property concerned, as
this indicates that the
individual is living at the
property.
1
The individual(s) making the request:
Name:
Property number:
Street name:
Town:
County:
Postcode:
Phone no:
Email address:
Name:
Property number:
Street name:
Town:
County:
Postcode:
Phone no:
Email address:
Enter the full postal address
of the property for which a
restriction is requested
You must use a separate
form for each property.
2
Property address:
Property number:
Street name:
Town:
County:
Postcode:
If you know the title number
of the property, enter it here.
If you don’t know the title
number, leave this section
blank.
3
For official use only
Land Registry TIS
code RXL
Page 2 of 2 RQ (Revised 3/14)
Complete section 4 if you
are not a conveyancer.
4
I am/we are, or following registration will be, the registered proprietor, or one or more
of the registered proprietors, of the property.
I am not/we are not living at the property and do not intend to do so.
I/we request Land Registry to enter in the register a restriction in the following form:
This is the wording that will
appear on your title when
the restriction is entered.
“No disposition of the registered estate by the proprietor of the registered estate is to
be registered without a certificate signed by a conveyancer that that conveyancer is
satisfied that the person who executed the document submitted for registration as
disponor is the same person as the proprietor.”
Each person named in
section 1 must sign.
Signed:
Date:
Signed:
Date:
Fill in section 5 only if you
are a conveyancer.
5
I am a conveyancer, as defined in rule 217A of the Land Registration Rules 2003,
and represent the above named individual(s).
I am instructed that they are not living at the property and have no immediate
intention to do so.
They request the registrar to enter the restriction set out in section 4.
Name of conveyancer:
Address or UK DX box number of conveyancer:
Town:
County:
Postcode:
Email address:
Reference:
Phone no:
Signed:
Date:
Public Guide 17 How to safeguard against property fraud contains general
information about action you can take to protect yourself against property fraud.
Please send the completed form by post or email to the address at the top of
page 1.
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.
© Crown copyright (ref: LR/HO) 3/14
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome