If you are paying by direct debit, this
will be the account charged.
This application is sent to Land Registry by
Key number (if applicable):
Address or UK DX box number:
Please note that the facility of issuing
results electronically is not available
at present. When it is, a direction will
appear on our website and details will
be given in Public Guide 1 and
Practice Guide 10. Until there is a
direction, you do not need to
complete this panel to obtain an
official copy in paper format.
Official copies issued electronically
are in 'Portable Document Format'
(PDF) which replicates the
appearance of the hard copy version.
You will need Adobe Acrobat Reader
(which you can install free from
www.adobe.com) to open the
Place 'X' in the box if applicable.
Issue of certificate of result of search in paper format where an
email address has been supplied
If you have supplied an email address in panel 4, then, unless
you complete the box below, any certificate of result of search of
the index map will be issued electronically to that address, if there
is a direction under section 100(4) of the Land Registration Act
2002 by the registrar covering such issuing.
I have supplied an email address but require the certificate of
result of search to be issued in paper format instead of being
Any attached plan must contain
sufficient details of the surrounding
roads and other features to enable
the land to be identified satisfactorily
on the Ordnance Survey map. A plan
may be unnecessary if the land can
be identified by postal description.
I apply for an official search of the index map in respect of the
land referred to in panel 2 shown on
the attached plan
Signature of applicant:
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) 10/13