Page 2 of 2 RQ (Revised 3/14)
Complete section 4 if you
are not a conveyancer.
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.”
section 1 must sign.
Fill in section 5 only if you
are a conveyancer.
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.
Address or UK DX box number of conveyancer:
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
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
© Crown copyright (ref: LR/HO) 3/14