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:
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
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
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.