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.
State reference, for example 'edged red'.
3
Property:
The statutory charge affects
the whole of each registered estate
the part(s) of the registered estate(s) shown on the attached
plan:
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 6.
4
Application and fee
Application
Fee paid (£)
Noting of priority of statutory
charge
Fee payment method
cheque made payable to 'Land Registry'
direct debit, under an agreement with Land Registry
Provide the full name(s) of the person(s)
applying for the noting of the overriding
priority. Where a conveyancer lodges the
application, this must be the name(s) of
the client(s), not the conveyancer.
5
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.
We will only issue warning of
cancellation letters to conveyancers
if an email address is inserted.
6
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:
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
is 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.
7
Documents lodged with this form:
Place 'X' in the appropriate box and
complete as necessary.
8
I certify that the statutory charge is already registered as entry
number in the charges register
I certify that the statutory charge has arisen and this is
evidenced by:
State the provision or other reason.
9
The applicant applies for an entry to be made in the register to
show that a statutory charge referred to in panel 8 has priority over
the charge(s) shown in panel 10. The statutory charge has priority
by virtue of:
If there are two or more charges of
the same date to the same lender,
you must clearly identify which
charge(s) priority is claimed over by
including a number or other identifier
for the charge in the first column.
10
Identify the charge(s) over which priority is claimed
Date of charge
Lender
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.
11
Signature of applicant
or their conveyancer:
Date:
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.
click to sign
signature
click to edit
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.
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