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.
This application is sent to Land Registry by
Key number (if applicable):
Address or UK DX box number:
Delete as appropriate.
Insert date and, if applicable, the
name(s) of person(s) named in the
Place 'X' in the appropriate box.
Insert date of charge and name of
the proprietor of the charge.
The applicant applies to [disapply] [modify] the restriction
registered on in favour of:
against the title number(s) listed in panel 2 which relate(s) to
the registered estate
the registered charge dated in favour of:
The registrar may make such
enquiries and serve such notices as
he thinks fit before making any
decision as to whether to make an
order, and if so, what order to make.
The applicant must produce such
further evidence or information as
the registrar requests.
The applicant has a sufficient interest in the restriction and details
of that interest are as follows:
The applicant considers that the registrar should make the order for
the following reason:
Give details of:
the disposition, or kind of
dispositions, to be affected, and
if the application is to modify the
restriction, the modification
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
Signature of applicant
or their conveyancer:
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