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 first registration of an estate, the title deeds having
been lost or destroyed.
Place 'X' in one box only.
This is for cases where the legal owner 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 legal owner.
Please specify and enclose any relevant
documentation (for example, office copy
grant of probate).
See note above.
2 Status of person making this statement
I am
the legal owner of the estate (other than as personal
representative)
making this statement on behalf of:
who is currently or was previously the legal owner but who
cannot make this statement for the following reasons:
other:
Insert postal address including postcode.
If no postal address insert description,
such as 'land adjoining 2 Acacia Avenue'.
Unless the land is shown with fully
defined features on the Ordnance Survey
map you must provide a plan showing the
extent of the land comprised in the lost or
destroyed title deeds. Place ‘X’ in the box,
if appropriate, and state the reference, for
example 'edged red’.
3 Description of the land:
The land is clearly identified on the attached plan and
shown:
Place 'X' in the appropriate box(es).
Please specify term.
Please specify.
4 Type of application
First registration of freehold estate in land
First registration of leasehold estate in land, the term being
years from:
Other:
Insert details of date and circumstances
in which the estate was acquired by the
current legal owner or (where the current
legal owner is a personal representative)
by the deceased previous legal owner.
5 Period of ownership of the estate:
Inse
r
t details of the person or body
having custody of the deeds and where
the deeds were being held at the time of
their loss or destruction.
6 Who had possession of the deeds and where they were held
when lost or destroyed:
Insert details of circumstances in which
the deeds were being held (for example
whether they were held for safekeeping
or as security for money owing or under a
lien).
7 Why the person in possession had custody of the deeds:
Insert details of date, place and
circumstances in which the deeds were
lost or destroyed.
8 When, where and how the loss or destruction occurred:
Insert details of searches, enquiries and
any other efforts made to recover the
deeds. Attach copies of any available
correspondence or other relevant
documents relating to this.
9 What steps have been taken to recover the deeds:
Place 'X' in one box only, and complete
the statement if applicable.
Insert details and confirm whether the
incumbrance is still subsisting and, if it is
not, provide evidence to establish its
repayment or discharge.
10 Mortgages, charges or liens etc
I confirm that at the time of the loss or destruction of the deeds
the legal owner had not created, nor was there otherwise
subsisting, any mortgage, charge or lien on the land nor
had the deeds been deposited with any person, firm or
body as security for money
the legal owner had created, or there was otherwise
subsisting, the following mortgage, charge or lien on the
land or the deeds had been deposited with the following
person, firm or body as security for money:
Insert details of the rights exercised by
the legal owner or (where the current
legal owner is a personal representative)
by the deceased previous legal owner.
Where the estate is an estate in land,
include details of the actual occupation of
the land and the receipt of any rents and
profits. Where it is a rentcharge, specify
the payments made, payer, payee,
amounts and dates.
Lodge any available evidence, such as
rent books or receipts.
Detail any third party rights or claims
which ma
y
exist.
11 Rights exercised by the legal owner and third party rights or
claims:
Complete this panel if copy deeds and/or
other documents are available in support
of the application and attach the copies to
this statement – otherwise proceed to
panel 13.
Insert details.
12 Reconstruction of title
I confirm that
the attached copy deeds and/or other documents have
been obtained from:
at the time of the estate being acquired by the current legal
owner or (where the current legal owner is a personal
representative) by the deceased previous legal owner, the
title had been investigated in the normal way
the conveyance, transfer or assignment to the current legal
owner or (where the current legal owner is a personal
representative) to the deceased previous legal owner, and
any mortgage, were properly executed and, where
appropriate, adequately stamped
13 Entitlement to apply fo
r
registration
I confirm that the applicant is entitled to apply for registration as
the legal estate is vested in them (or they have the right to
require the legal estate to be vested in them)
Please see Practice Guide 2 for further
details of Land Registry requirements.
14 Evidence of identity
The appropriate evidence of identity (where necessary) is
attached
Insert any other relevant details, (if any).
15 Other relevant details
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).
16 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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