This panel must always be
A key number is only available to
professional customers, such as
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.
We will only issue warning of
cancellation letters to conveyancers
if an email address is inserted.
This application is sent to Land Registry by
Key number (if applicable):
Address or UK DX box number:
Delete as appropriate.
Insert date and, if applicable, the
name(s) of person(s) named in the
Place 'X' in the appropriate box.
Insert date of charge and name of
the proprietor of the charge.
The applicant applies to [disapply] [modify] the restriction
registered on in favour of:
against the title number(s) listed in panel 2 which relate(s) to
the registered estate
the registered charge dated in favour of:
The registrar may make such
enquiries and serve such notices as
he thinks fit before making any
decision as to whether to make an
order, and if so, what order to make.
The applicant must produce such
further evidence or information as
the registrar requests.
The applicant has a sufficient interest in the restriction and details
of that interest are as follows:
The applicant considers that the registrar should make the order for
the following reason:
Give details of:
− the disposition, or kind of
dispositions, to be affected, and
− if the application is to modify the
restriction, the modification
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
Signature of applicant
or their conveyancer:
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.
click to sign
click to edit