If you need more room than is provided for in a panel, and your
software allows, you can expand any panel in the form. Alternatively
use continuation sheet CS and attach it to this form.
Land Registry is unable to give legal advice but our website
www.landregistry.gov.uk provides guidance on Land Registry
applications. This includes public guides and practice guides (aimed
at conveyancers) that can also be obtained from any Land Registry
office.
See www.landregistry.gov.uk/contact-us/offices if you are unsure
which Land Registry office to send this application to.
Conveyancer is a term used in this form. It is defined in rule 217A,
Land Registration Rules 2003 and includes persons authorised under
the Legal Services Act 2007 to provide reserved legal services
relating to land registration and includes solicitors and licensed
conveyancers.
LAND REGISTRY USE ONLY
Record of fees paid
Particulars of under/over payments
Reference number
Fees debited £
Where there is more than one local
authority serving an area, enter the
one to which council tax or business
rates are normally paid.
1
Local authority serving the property:
2
Title number(s) of the property:
Insert address including postcode (if
any) or other description of the
property, for example ‘land adjoining
2 Acacia Avenue’.
Place 'X' in the appropriate box.
Give a brief description of the part
affected, for example ‘edged red on
the attached plan’.
Complete details of charge if
appropriate.
3
Property:
The restriction applied for is to affect
the whole of the registered estate
the part(s) of the registered estate as shown:
the registered charge(s) dated in
favour of:
See fees calculator at
www.landregistry.gov.uk/professional
/fees/fees-calculator
Place 'X' in the appropriate box.
The fee will be charged to the
account specified in panel 7.
4
Application and fee
Fee paid (£)
Fee payment method
cheque made payable to 'Land Registry'
direct debit, under an agreement with Land Registry
List the documents lodged with this
form. If this application is
accompanied by either Form AP1 or
FR1 please only complete the
corresponding panel on Form AP1 or
DL (if used). Original documents are
only required if your application is a
first registration, when we will return
the originals if a certified copy has
been supplied. If your application is
not a first registration then we only
need certified copies of deeds or
documents you send to us with Land
Registry application forms. Once we
have made a copy of the documents
you send to us, they will be
destroyed, this applies to both
originals and certified copies.
5
Documents lodged with this form:
Provide the full name(s) of the
person(s) applying to enter the
restriction. Where a conveyancer
lodges the application, this must be
the name(s) of the client(s), not the
conveyancer.
6
The applicant:
If you are paying by direct debit, this
will be the account charged.
This is the address to which we will
normally send requisitions. However
if you insert an email address, we will
use this whenever possible. Where
an application is lodged by e-DRS all
documents and correspondence will
be dealt with electronically.
7
This application is sent to Land Registry by
Key number (if applicable):
Name:
Address or UK DX box number:
Email address:
Reference:
Phone no:
Fax no:
You must place 'X' in only one box
in this panel. See Practice Guide 19
if you are unsure which option you
need to select.
8
The applicant is entitled to apply for a restriction because
(A) Applicant is the registered proprietor
The applicant is the registered proprietor of the estate/charge
referred to in panel 3
If you are a conveyancer the
certificate is sufficient to comply with
Land Registry’s requirements. If no
conveyancer is acting, you must
enclose evidence of the applicant’s
entitlement to be registered as
proprietor with this application. Land
Registry may destroy documents
after scanning.
List any supporting documents in
panel 5 or on Form AP1 or DL (if
used).
(B) Applicant is entitled to be registered as the proprietor
Evidence of that entitlement accompanies this application
I am the applicant’s conveyancer and certify that I am satisfied
that the applicant is entitled to be registered as proprietor and
that I hold the originals of the documents that contain evidence
of the applicant’s entitlement, or an application for registration
of the applicant as proprietor is pending at Land Registry
If you are a conveyancer the
certificate is sufficient to comply with
Land Registry’s requirements. If no
conveyancer is acting, you must
enclose the relevant consent with
this application. Land Registry may
destroy documents after scanning.
(C) Application made with the consent of the registered
proprietor
The relevant consent accompanies this application
I am the applicant’s conveyancer and certify that I hold the
relevant consent
If you are a conveyancer the
certificate is sufficient to comply with
Land Registry’s requirements. If no
conveyancer is acting, you must
enclose the relevant consent and
evidence of entitlement to be
registered as proprietor with this
application. Land Registry may
destroy documents after scanning.
List any supporting documents in
panel 5 or on Form AP1 or DL (if
used).
(D) Application made with the consent of person entitled to be
registered as proprietor
The relevant consent and evidence of that entitlement
accompany this application
I am the applicant’s conveyancer and I certify that the relevant
consent accompanies this application.
I also certify that I am satisfied that the person consenting to
this application is entitled to be registered as proprietor and
that I hold the originals of the documents that contain evidence
of that person’s entitlement, or an application for registration of
that person as proprietor is pending at Land Registry
I am the applicant’s conveyancer and I certify that I hold the
relevant consent.
I also certify that I am satisfied that the person consenting to
this application is entitled to be registered as proprietor and
that I hold the originals of the documents that contain evidence
of that person’s entitlement, or an application for registration of
that person as proprietor is pending at Land Registry
List any supporting documents in
panel 5 or on Form AP1 or DL (if
used).
(E) Other evidence in support of applicant’s claim
None of the above statements applies but the applicant has
the following sufficient interest in the making of the entry of the
restriction applied for in panel 9
The applicant has made the statement in panel 12
I am the applicant’s conveyancer and I certify as to the
applicant’s interest in panel 13
Set out in full the wording of the
restriction required. For standard form
restrictions, also insert the reference
letter(s) of the form. For non-standard
form restrictions delete the words in
square brackets. Standard forms of
restriction are set out in Schedule 4 to
the Land Registration Rules 2003.
Further guidance is contained in
Practice Guide 19.
You must set out the wording of the
restriction in full, unless you are
applying for a standard form of
restriction that has no variable content.
You must include the address(es) for
service where a standard form of
restriction requires an address to be
included or where any other restriction
requires a consent or certificate to be
provided, or notice to be served on the
restrictioner. Each restrictioner may
give up to three addresses for service,
one of which must be a postal address
whether or not in the UK (including the
postcode, if any). The others can be
any combination of a postal address, a
UK DX box number or an electronic
address.
If the restriction refers to a registered
company or limited liability partnership
incorporated anywhere in the United
Kingdom include the registered number
(including any prefix) immediately after
the name of the company. For an
overseas company include the territory
of incorporation and if its particulars are
registered at Companies House, state
the registered number in England and
Wales.
9
The applicant applies to enter a restriction [in standard form
] against the estate/charge referred to in panel 3 in
the following words:
If a conveyancer is acting for the
applicant, that conveyancer must sign.
If no conveyancer is acting, the
applicant (and if more than one person
then each of them) must sign.
The conveyancer must sign if they have
given one of the certificates referred to
in panel 8.
10
Signature of applicant
or their conveyancer:
Date:
See panel 8.
11
I/We consent to the entry of the restriction specified in panel 9
against the estate or charge referred to in panel 3.
Print full name
Signature
1.
1.
2.
2.
3.
3.
4.
4.
Only complete this panel if you have
completed option (E) in panel 8. If a
conveyancer is lodging the application,
the conveyancer may either complete
panel 13 and leave this panel blank, or
may arrange for the applicant to
complete this panel.
Set out the nature of the applicant’s
interest.
Set out details of the circumstances in
which the interest arose.
List any supporting documents in panel
5 or on Form AP1 or DL (if used).
See the warnings at the end of this
form.
12
The applicant states that the applicant has a sufficient interest
in the restriction being entered in the register.
Nature of applicant’s interest:
Details of how the applicant’s interest arose:
Signature of applicant:
Only complete this panel if you have
completed option (E) in panel 8 and a
conveyancer is lodging the application.
Set out the nature of the applicant’s
interest.
Set out details of the circumstances in
which the interest arose.
List any supporting documents in panel
5 or on Form AP1 or DL (if used).
See the warnings at the end of this
form.
13
I certify that the applicant has a sufficient interest in the
restriction being entered in the register.
Nature of applicant’s interest:
Details of how the applicant’s interest arose:
Signature of conveyancer:
The conveyancer's full name is:
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.
Under section 66 of the Land Registration Act 2002 most documents (including this form) kept by the registrar relating to an
application to the registrar or referred to in the register are open to public inspection and copying. If you believe a document
contains prejudicial information, you may apply for that part of the document to be made exempt using Form EX1, under rule 136
of the Land Registration Rules 2003.
© Crown copyright (ref: LR/HO) 06/14
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