Each proprietor may give up to three
addresses for service, one of which
must be a postal address whether or
not in the UK (including the postcode,
if any). The others can be any
combination of a postal address, a
UK DX box number or an electronic
Lender’s intended address(es) for service for entry in the register:
Place ‘X’ in any box that applies.
Add any modifications.
The borrower with
full title guarantee
limited title guarantee
charges the property by way of legal mortgage as security for the
payment of the sums detailed in panel 9
Place 'X' in the appropriate box(es).
You must set out the wording of the
restriction in full.
Standard forms of restriction are set
out in Schedule 4 to the Land
Registration Rules 2003.
The lender is under an obligation to make further advances
and applies for the obligation to be entered in the register
The borrower applies to enter the following standard form of
restriction in the proprietorship register of the registered
Insert details of the sums to be paid
(amount and dates) and so on.
The borrower must execute this
charge as a deed using the space
opposite. If there is more than one
borrower, all must execute. Forms of
execution are given in Schedule 9 to
the Land Registration Rules 2003. If
a note of an obligation to make
further advances has been applied
for in panel 8 this document must be
signed by the lender or its
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.