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
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
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.
Local authority serving the property:
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.
State reference, for example 'edged
The statutory charge affects
the whole of each registered estate
the part(s) of the registered estate(s) shown on the attached
See fees calculator at
Place 'X' in the appropriate box.
The fee will be charged to the
account specified in panel 6.
Application and fee
Fee paid (£)
Fee payment method
cheque made payable to 'Land Registry'
direct debit, under an agreement with Land Registry
Provide the full name(s) of the
person(s) applying for the noting of
the overriding priority. Where a
conveyancer lodges the application,
this must be the name(s) of the
client(s), not the conveyancer.
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.
This application is sent to Land Registry by
Key number (if applicable):
Address or UK DX box number:
Email address:
Phone no:
Fax no:
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
is 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.
Documents lodged with this form:
Place 'X' in the appropriate box and
complete as necessary.
I certify that the statutory charge is already registered as entry
number in the charges register
I certify that the statutory charge has arisen and this is
evidenced by:
State the provision or other reason.
The applicant applies for an entry to be made in the register to
show that a statutory charge referred to in panel 8 has priority over
the charge(s) shown in panel 10. The statutory charge has priority
by virtue of:
If there are two or more charges of
the same date to the same lender,
you must clearly identify which
charge(s) priority is claimed over by
including a number or other identifier
for the charge in the first column.
Identify the charge(s) over which priority is claimed
Date of charge
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