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’).
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 office.
Insert full name.
Insert full address.
1 I:
of:
make this statement in support of an application to Land
Registry for registration based upon adverse possession.
Place 'X' in one box only.
This is for cases where the squatter 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 squatter.
Insert reasons and describe the
relationship of the person making the
statement to the person on whose behalf
it is made. Enclose any relevant
documentation (for example, office copy
grant of probate).
2 Status
I am
the person currently in adverse possession
a person who was previously in adverse possession
making this statement on behalf of:
who is currently or was previously in adverse possession
but who cannot make this statement for the following
reasons:
Insert address including postcode (if any)
or other description of the property, for
example ‘land adjoining 2 Acacia
A
venue’.
Place 'X' in the appropriate box(es) and
complete the relevant statement.
State reference, for example ‘edged red’.
Insert title number(s) if the land is already
registered. If only part of a registered title
is affected the affected land should be
clearly identified on an attached plan or
by means of an existing reference on the
title plan.
3 Property:
The land is clearly identified on the attached plan and
shown:
The land is currently registered under title number(s):
Insert the dates the adverse possession
started and finished. Any ‘gaps’ must be
specified if the period is not continuous.
Only include the period of adverse
possession by the person making this
statement or on whose behalf it is made.
4 Period of adverse possession:
Insert details of the acts relied on as
establishing the necessary factual
possession and intention to possess.
Include details of the use made of the
land by the owner and others.
5
A
cts of adverse possession:
Insert details of the extent, if any, to
which the land has been and/or is
enclosed by fences or other boundary
features. Specify the nature of these
features, who erected them and when,
and by whom they have been maintained.
If there is a gate, specify whether there is
a lock for it and, if so, who has the key. If
any previous boundary features have
been removed, specify when, by whom
and in what circumstances this was done.
6 Enclosure of the land:
Place 'X' in the appropriate box(es) and
complete the statement if applicable.
Insert details of, for example, any tenancy
or licence under which possession has
been enjoyed, including the date of its
expiry or determination.
Insert details.
7 Permission to possess
The possession has been
without the consent, licence or permission of anyone at
any time
by virtue of the following consent, licence or permission,
which has expired or determined:
by virtue of the following consent, licence or permission:
Insert name and address of any known
freehold owner of the land or person
thought to be the freehold owner (such as
the person having the unregistered
documentary title to the land or being the
registered proprietor of registered land)
and/or any tenants and/or mortgagees. If
not known, please state this by inserting
‘not known’. If the land is unregistered,
copies of any title deeds or other relevant
documentation should be lodged, if
available.
8 Details of any known freehold owner of the land or person
thought to be the freehold owner and related persons:
Insert details of any past or present
contact with the freehold owner of the
land or person thought to be the freehold
owner and/or any tenants and/or
mortgagees, including dates. If none,
please state this by inserting ‘none’. If
there has been any dispute concerning
the adverse possession, insert details,
including dates. Attach copies of all
available correspondence or other
documents relating to the contact or
dispute.
9 Contact with freehold owner of the land and related persons:
Insert details of such property. Where the
title to this other property is registered,
please quote the relevant title number(s)
and provide copies of the relevant pre-
registration title deeds. Where the title to
this other property is unregistered, please
confirm whether this is freehold or
leasehold and provide copies of the
relevant title deeds.
10 Other property owned during the period referred to in panel 4
by the person making this statement or the person on behalf of
whom this statement is made:
Insert other relevant details, (if any).
11 Other relevant details
Place 'X' in the box against each of the
statements being made, and complete
one or both of the final statements if they
are being made.
You must make the first three statements,
otherwise your application may be
cancelled.
Insert details of the facts.
Insert details of the facts.
12 If the application is under paragraph 1 of Schedule 6 to the
Land Registration Act 2002 AND you are the applicant
Paragraph 1(3) of Schedule 6 to the Land Registration Act
2002 does not apply
I confirm that to the best of my knowledge the restriction
on applications in paragraph 8 of Schedule 6 to the Land
Registration Act 2002 does not apply
I confirm that to the best of my knowledge the estate is
not, and has not been during any of the period of claimed
adverse possession, subject to a trust (other than one
where the interest of each of the beneficiaries is an
interest in possession)
Should a person given notice under paragraph 2 of
Schedule 6 to the Land Registration Act 2002 require the
application to be dealt with under paragraph 5 of that
Schedule, the facts supporting my reliance on one or more
of the conditions set out in that paragraph are as follows:
I am relying on paragraph 1(2) of Schedule 6 to the Land
Registration Act 2002 and the facts supporting such
reliance are as follows:
Place 'X' in the box against each of the
statements being made, and complete
the final statement.
You must make all these statements, and
complete the final statement, otherwise
your application may be cancelled.
Insert full details.
13 If the application is under paragraph 6 of Schedule 6 to the
Land Registration Act 2002 AND you are the applicant
Paragraph 6(2) of Schedule 6 to the Land Registration Act
2002 does not apply
I confirm that to the best of my knowledge the restriction
on applications in paragraph 8 of Schedule 6 to the Land
Registration Act 2002 does not apply
I confirm that to the best of my knowledge the estate is
not, and has not been during any of the period of claimed
adverse possession, subject to a trust (other than one
where the interest of each of the beneficiaries is an
interest in possession)
The full details of the rejected application are as follows:
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).
Where the application is being made
under Schedule 6 and the person making
this statement, or on whose behalf it is
made, is the applicant, the statement
must be made not more than one month
before the date of the application.
14 I believe that the facts and matters contained in this statement
are true
Signature (of person
making this statement):
Print full name:
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 necessar
y
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 re
g
ister.
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 Re
g
istration Rules 2003.
© Crown copyright (ref: LR/HO) 10/12
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