You must explain how the interest has
passed.
If the interest has passed to the registered proprietor or
proprietors, or the survivor(s) of them, explain how this
happened. (Provide accurate and relevant information.)
Where only one registered proprietor
will remain on the register, complete
panel 5.
HM Land Registry cannot consider the
application if you are not able to
confirm both statements.
Where there remains one registered proprietor:
I confirm that no one other than the remaining/surviving
registered proprietor now has a beneficial interest in the
property.
AND
I confirm that no beneficial interest in the property has
been separately mortgaged or charged, and that no
beneficial owner is or was subject to a charging order or
bankruptcy proceedings.
Where two or more registered
proprietors will remain on the register,
please complete panel 6.
HM Land Registry cannot consider the
application if you are not able to
confirm both statements.
Where there remain two or more registered proprietors:
We confirm that they hold the property on trust for
themselves (and no one else) as beneficial joint
tenants.
AND
We confirm that no beneficial interest in the property
has been separately mortgaged or charged, and that no
beneficial owner is or was subject to a charging order or
bankruptcy proceedings.
If a joint statement is made by two or
more persons, all must sign this
statement.
If a person making the statement is
unable to sign it or is unable to read, a
conveyancer eg a solicitor, will have to be
involved who must give the appropriate
certificate as required by rule 215A (4),
(5) and (6) of the Land Registration Rules
2003.
I/We believe that the facts and matters contained in this
statement are true
Signature(s) (of person(s)
making this statement):
Print full name(s):
Date:
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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