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 and/or noting of an easement based
upon prescription.
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.
See note above.
2 Status of person making this statement
I am
the legal owner of the benefiting land (other than as
personal representative)
making this statement on behalf of:
who is currently or was previously the legal owner of the
benefiting land but who cannot make this statement for the
following reasons:
other:
Place 'X' in one box only.
If applying for entry of a unilateral notice,
do not use this form - please use form
UN1 instead.
3 Type of application
Registration of benefit of an easement – benefiting land is
registered and burdened land is unregistered
Registration of benefit of easement and entry of notice of
burden – benefiting land is registered and burdened land is
registered
Entry of notice of burden of easement – burdened land is
registered and benefiting land is unregistered
4
Title number(s) of the benefiting land (if registered):
Insert address including postcode (if any)
or other description of the property, for
example 'land adjoining 2 Acacia
Avenue'.
If the benefit of the easement is claimed
in relation to unregistered land or part
only of the land in the claimant’s
registered title(s), you must identify the
benefiting land by attaching a plan
showing the relevant land or (if
appropriate) by referring to an existing
reference on the title plan.
Place 'X' in the appropriate box(es) and
complete the first statement if
appropriate.
Enter reference, for example 'edged red'.
If the benefiting land is unregistered,
enclose any copy title deeds, if available.
5 Description of the benefiting land:
The land is clearly identified on the attached plan and
shown:
The land is unregistered and is comprised in the copy title
deeds enclosed
6 Title number(s) of the burdened land (if registered):
Insert address including postcode (if any)
or other description of the property, for
example 'land adjoining 2 Acacia
Avenue'.
If the easement affects unregistered land
or part only of the land in one or more
registered titles, you must identify the
burdened land by attaching a plan
showing the relevant land or (if
appropriate) by referring to an existing
reference on the title plan.
Place 'X' in the appropriate box(es) and
complete the first statement if
appropriate.
Enter reference, for example 'edged red'.
If the burdened land is unregistered,
enclose any copy title deeds, if available.
7 Description of the burdened land:
The land is clearly identified on the attached plan and
shown:
The land is unregistered and is comprised in the copy title
deeds enclosed
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’.
8 Identity of the freehold owner of the burdened land or person
thought to be the owner and related persons:
Describe the easement claimed to have
been acquired by prescription as it might
be described in the register. For
example, ‘a right of way with or without
vehicles for the benefit of [describe
benefiting land] over [describe burdened
land]’.
9 Easement claimed:
Insert details of the facts relied on to
support the claim that an easement has
been acquired by prescription.
10 Details of user:
Insert details of date and circumstances
in which the user in panel 10 started and
finished. Any ‘gaps’ must be specified if
the period is not continuous.
11 Period of user:
Place 'X' in one box only and complete
the relevant statement if appropriate.
Insert details, including dates, and attach
any available correspondence or other
relevant documentation.
If you place 'X' in the second box you are
unlikely to establish a claim to the
easement b
y
prescription.
12 User without force, secrecy or permission
I confirm that
to the best of my knowledge and belief, the user has
always been exercised without force, secrecy or
permission
the user has not always been exercised without force,
secrecy or permission because:
Insert details of any past or present
contact with the owner of the burdened
land or person thought to be the owner
and/or any tenants and/or mortgagees of
that land, including dates. If none, please
state this by inserting ‘none’. If there has
been any dispute concerning the claimed
right, please provide details, including
dates. Attach copies of all available
correspondence or documents relating to
the contact or dispute.
13 Contact with freehold owner of the burdened land and related
persons:
Insert other relevant details, (if any).
14 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).
15 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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