Any parts of the form that are not typed should be completed in black ink and in block capitals.
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.
If a joint statement is made by two or more persons, consequential amendments can be made to the text in the
panels (for example, ‘I’ can be changed to ‘we’).
HM Land Registry is unable to give legal advice, but you can find guidance on HM Land Registry applications
(including our practice guides for conveyancers) at www.gov.uk/land-registry.
For information on how HM Land Registry processes your personal information, see our Personal Information
Charter.
Insert full name.
Insert full address.
1
I:
of:
make this statement in support of an application to Land
Registry for first registration of an estate, the title deeds having
been lost or destroyed.
Place 'X' in one box only.
This is for cases where the legal owner is
a company or firm, someone who has
died, or is otherwise incapable of making
the statement personally. Insert the name
and address of the legal owner.
Please specify and enclose any relevant
documentation (for example, office copy
grant of probate).
See note above.
2
Status of person making this statement
I am
the legal owner of the estate (other than as personal
representative)
making this statement on behalf of:
who is currently or was previously the legal owner but who
cannot make this statement for the following reasons:
other:
Insert postal address including postcode.
If no postal address insert description,
such as 'land adjoining 2 Acacia Avenue'.
Unless the land is shown with fully
defined features on the Ordnance Survey
map you must provide a plan showing the
extent of the land comprised in the lost or
destroyed title deeds. Place ‘X’ in the box,
if appropriate, and state the reference, for
example 'edged red’.
3
Description of the land:
The land is clearly identified on the attached plan and
shown:
Place 'X' in the appropriate box(es).
Please specify term.
Please specify.
4
Type of application
First registration of freehold estate in land
First registration of leasehold estate in land, the term being
years from:
Other:
Insert details of date and circumstances
in which the estate was acquired by the
current legal owner or (where the current
legal owner is a personal representative)
by the deceased previous legal owner.
5
Insert details of the person or body
having custody of the deeds and where
the deeds were being held at the time of
their loss or destruction.
6
Insert details of circumstances in which
the deeds were being held (for example
whether they were held for safekeeping
or as security for money owing or under a
lien).
7
Insert details of date, place and
circumstances in which the deeds were
lost or destroyed.
8
Insert details of searches, enquiries and
any other efforts made to recover the
deeds. Attach copies of any available
correspondence or other relevant
documents relating to this.
9
Place 'X' in one box only, and complete
the statement if applicable.
Insert details and confirm whether the
incumbrance is still subsisting and, if it is
not, provide evidence to establish its
repayment or discharge.
10
Where the estate is an estate in land,
include details of the use and actual
occupation of the land and/or the receipt
of rents or profits. Where it is a
rentcharge, specify the payments made,
payer, payee, amounts and dates.
Lodge any available evidence, such as
rent books or receipts.
11a
Include details of any rights exercised by
the legal owner. Where the current legal
owner is the personal representative,
include details of any rights exercised by
the deceased previous legal owner.
Detail any third party rights or claims
which may exist.
11b
Complete this panel if copy deeds and/or
other documents are available in support
of the application and attach the copies to
this statement otherwise proceed to
panel 13.
Insert details.
12
13
Please see practice guide 2 available on
the GOV.UK website for further details of
HM Land Registry requirements.
14
Insert any other relevant details, (if any).
15
If the person making the statement is
unable to sign it, this wording will need to
be amended to comply with rule 215A(5)
and (6) of the Land Registration Rules
2003. In addition, and in cases where the
person making the statement is unable to
read, there will need to be an appropriate
certificate: see rule 215A(4) and (5).
16
I believe that the facts and matters contained in this statement
are true
Signature (of person
making this statement):
Print full name:
Date:
click to sign
signature
click to edit
WARNING
If the application proceeds, notice of the application (accompanied by a copy of this statement of truth) may be sent by the
registrar to the owner of the land or any person thought to be the owner and/or any other person upon whom the registrar
considers it necessary or desirable to serve notice.
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) 05/18
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