Any parts of the form that are not typed should be completed in
black ink and in block capitals.
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.
HM Land Registry is unable to give legal advice, but you can find
guidance on HM Land Registry applications (including our practice
guides for conveyancers) at www.gov.uk/land-registry.
Conveyancer is a term used in this form. It is defined in rule 217A,
Land Registration Rules 2003 and includes persons authorised under
the Legal Services Act 2007 to provide reserved legal services
relating to land registration and includes solicitors and licensed
conveyancers.
For information on how HM Land Registry processes your personal
information, see our Personal Information Charter.
HM LAND REGISTRY USE ONLY
Record of fees paid
Particulars of under/over payments
Reference number
Fees debited £
Where there is more than one local
authority serving an area, enter the one
to which council tax or business rates are
normally paid.
1
Local authority serving the property:
2
Title number(s) of the property:
Insert address including postcode (if any)
or other description of the property, for
example ‘land adjoining 2 Acacia
Avenue’.
Place 'X' in the appropriate box.
Give a brief description of the part
affected, for example ‘edged red on the
attached plan’.
Complete details of charge if appropriate.
3
Property:
The restriction applied for is to affect
the whole of the registered estate
the part(s) of the registered estate as shown:
the registered charge(s) dated in
favour of:
To find out more about our fees visit
www.gov.uk/government/collections/fees-
land-registry-guides
Place 'X' in the appropriate box.
The fee will be charged to the account
specified in panel 7.
4
Application and fee
Application
Fee paid (£)
Entry of restriction
Fee payment method
cheque made payable to 'Land Registry'
direct debit, under an agreement with Land Registry
List the documents lodged with this form.
If this application is accompanied by
either Form AP1 or FR1 please only
complete the corresponding panel on
Form AP1 or DL (if used). Original
documents are only required if your
application is a first registration, when we
will return the originals if a certified copy
has been supplied. If your application is
not a first registration then we only need
certified copies of deeds or documents
you send to us with HM Land Registry
application forms. Once we have made a
copy of the documents you send to us,
they will be destroyed, this applies to
both originals and certified copies.
5
Documents lodged with this form:
Provide the full name(s) of the person(s)
applying to enter the restriction. Where a
conveyancer lodges the application, this
must be the name(s) of the client(s), not
the conveyancer.
6
The applicant:
This panel must always be completed.
A key number is only available to
professional customers, such as
solicitors.
If you are paying by direct debit, this will
be the account charged.
This is the address to which we will
normally send requisitions. However if
you insert an email address, we will use
this whenever possible. Where an
application is lodged by e-DRS all
documents and correspondence will be
dealt with electronically.
We will only issue warning of cancellation
letters to conveyancers if an email
address is inserted.
7
This application is sent to Land Registry by
Key number (if applicable):
Name:
Address or UK DX box number:
Email address:
Reference:
Phone no:
Fax no:
You must place 'X' in only one box
in this panel. See Practice Guide 19
if you are unsure which option you
need to select.
8
The applicant is entitled to apply for a restriction because
(A) Applicant is the registered proprietor
The applicant is the registered proprietor of the estate/charge
referred to in panel 3
If you are a conveyancer the
certificate is sufficient to comply with
HM Land Registry’s requirements. If
no conveyancer is acting, you must
enclose evidence of the applicant’s
entitlement to be registered as
proprietor with this application. HM
Land Registry may destroy
documents after scanning.
List any supporting documents in
panel 5 or on Form AP1 or DL (if
used).
(B) Applicant is entitled to be registered as the proprietor
Evidence of that entitlement accompanies this application
I am the applicant’s conveyancer and certify that I am satisfied
that the applicant is entitled to be registered as proprietor and
that I hold the originals of the documents that contain evidence
of the applicant’s entitlement, or an application for registration
of the applicant as proprietor is pending at Land Registry
If you are a conveyancer the
certificate is sufficient to comply with
HM Land Registry’s requirements. If
no conveyancer is acting, you must
enclose the relevant consent with
this application. HM Land Registry
may destroy documents after
scanning.
(C) Application made with the consent of the registered
proprietor
The relevant consent accompanies this application
I am the applicant’s conveyancer and certify that I hold the
relevant consent
If you are a conveyancer the
certificate is sufficient to comply with
HM Land Registry’s requirements. If
no conveyancer is acting, you must
enclose the relevant consent and
evidence of entitlement to be
registered as proprietor with this
application. HM Land Registry may
destroy documents after scanning.
List any supporting documents in
panel 5 or on Form AP1 or DL (if
used).
(D) Application made with the consent of person entitled to be
registered as proprietor
The relevant consent and evidence of that entitlement
accompany this application
I am the applicant’s conveyancer and I certify that the relevant
consent accompanies this application.
I also certify that I am satisfied that the person consenting to
this application is entitled to be registered as proprietor and
that I hold the originals of the documents that contain evidence
of that person’s entitlement, or an application for registration of
that person as proprietor is pending at Land Registry
I am the applicant’s conveyancer and I certify that I hold the
relevant consent.
I also certify that I am satisfied that the person consenting to
this application is entitled to be registered as proprietor and
that I hold the originals of the documents that contain evidence
of that person’s entitlement, or an application for registration of
that person as proprietor is pending at Land Registry
List any supporting documents in
panel 5 or on Form AP1 or DL (if
used).
(E) Other evidence in support of applicant’s claim
None of the above statements applies but the applicant has
the following sufficient interest in the making of the entry of the
restriction applied for in panel 9
The applicant has made the statement in panel 12
I am the applicant’s conveyancer and I certify as to the
applicant’s interest in panel 13
Set out in full the wording of the
restriction required. For standard form
restrictions, also insert the reference
letter(s) of the form. For non-standard
form restrictions delete the words in
square brackets. Standard forms of
restriction are set out in Schedule 4 to
the Land Registration Rules 2003.
Further guidance is contained in
Practice Guide 19.
You must set out the wording of the
restriction in full, unless you are
applying for a standard form of
restriction that has no variable content.
You must include the address(es) for
service where a standard form of
restriction requires an address to be
included or where any other restriction
requires a consent or certificate to be
provided, or notice to be served on the
restrictioner. Each restrictioner 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
address.
If the restriction refers to a registered
company or limited liability partnership
incorporated anywhere in the United
Kingdom include the registered number
(including any prefix) immediately after
the name of the company. For an
overseas company include the territory
of incorporation and if its particulars are
registered at Companies House, state
the registered number in England and
Wales.
9
The applicant applies to enter a restriction [in standard form
] against the estate/charge referred to in panel 3 in
the following words:
If a conveyancer is acting for the
applicant, that conveyancer must sign.
If no conveyancer is acting, the
applicant (and if more than one person
then each of them) must sign.
The conveyancer must sign if they have
given one of the certificates referred to
in panel 8.
10
Signature of applicant
or their conveyancer:
Date:
See panel 8.
11
I/We consent to the entry of the restriction specified in panel 9
against the estate or charge referred to in panel 3.
Print full name
Signature
1.
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2.
2.
3.
3.
4.
4.
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Only complete this panel if you have
completed option (E) in panel 8. If a
conveyancer is lodging the application,
the conveyancer may either complete
panel 13 and leave this panel blank, or
may arrange for the applicant to
complete this panel.
Set out the nature of the applicant’s
interest.
Set out details of the circumstances in
which the interest arose.
List any supporting documents in panel
5 or on Form AP1 or DL (if used).
See the warnings at the end of this
form.
12
The applicant states that the applicant has a sufficient interest
in the restriction being entered in the register.
Nature of applicant’s interest:
Details of how the applicant’s interest arose:
Signature of applicant:
Only complete this panel if you have
completed option (E) in panel 8 and a
conveyancer is lodging the application.
Set out the nature of the applicant’s
interest.
Set out details of the circumstances in
which the interest arose.
List any supporting documents in panel
5 or on Form AP1 or DL (if used).
See the warnings at the end of this
form.
13
I certify that the applicant has a sufficient interest in the
restriction being entered in the register.
Nature of applicant’s interest:
Details of how the applicant’s interest arose:
Signature of conveyancer:
The conveyancer's full name is:
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.
© Crown copyright (ref: LR/HO) 05/18
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