© Crown copyright (ref: LR/HO 05/18)
Add your full name, along with the name
of anyone else making this application.
If you are a conveyancer, this must be
the name(s) of your client(s).
You must add a name and address - we’ll
use this to return documents when your
application is complete or if we need to
ask for more information.
If you are a conveyancer, we’ll only send
‘warning of cancellation’ letters to email
addresses.
You must add your name and address to this section – we can’t
process your application without them:
This application is sent to HM Land Registry by:
Name:
Address:
Email address (optional):
Phone number:
For completion by conveyancers only:
Reference:
Key number:
Please complete A and C.
If you are a conveyancer, please
complete B and C.
Application
A. I/We:
B. I/We as conveyancers for:
C. hereby apply to remove from the register the name of:
who died on:
at (place of death):
Only complete this section if the
deceased’s name or address on the death
certificate, probate or letters of
administration is different from the details
on the title register.
I/We certify that:
(name of deceased, as
shown on section 4 evidence of death)
is the same person as shown in the title register for the property.
All applicants named in section 5 must
sign this application.
If you are a conveyancer, please sign on
behalf of the applicant(s).
Please send this application form
and evidence of death to:
HM Land Registry Citizen Centre,
PO Box 74, Gloucester, GL14 9BB.
If you are a conveyancer, send the
application form by e-DRS or to:
HM Land Registry
(insert your customer team's office name
or your closest office, such as ‘Fylde’),
PO Box 75, Gloucester, GL14 9BD.
or
HM Land Registry
(insert your customer team's office name
or your closest office, such as ‘Fylde’),
DX 321601 Gloucester 33.
Warning
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.
click to sign
signature
click to edit