That I am (or we are) the registered proprietor(s) of [full official description of land, including the area and title or index book reference; also the street or general locality in which the land is situated] (and of the following relative shares, namely, [specify particulars]).

That the full name, address, and occupation of my wife (or husband) is [to be completed if the title is in the name of 1 person only].

That my wife (or husband) and I (or we) at present (or will within 6 months of the date) reside and have our home in a dwellinghouse (or flat) erected on the said land.

That the said dwellinghouse (or flat) and land are (or will within 6 months of the date be) used exclusively as a home for my wife (or husband) and me (or for us) and the following members of our household, namely [state names and relationship], except to this extent, namely: [if the dwellinghouse and land are used exclusively for the above purposes, delete the words “except to this extent, namely”; if they are not used exclusively for the above purposes but, if it is submitted that they are used principally for these purposes, add, after the words “except to this extent, namely”, the other uses to which they are being put].

That I am (or we are) able at the date to pay all my (or our) debts other than debts charged on the property that is being settled without the aid of that property.

That I am not, and my wife (or husband) is not, (or neither of us is) the owner, or a joint owner, of any other joint family home registered as such under the provisions of the Joint Family Homes Act 1964; and that we have/have not previously been the joint tenants under that Act of a joint family home (at [specify]) [give full address if applicable].

That the place (or several places) where I (or we) have during the 12 months preceding the date resided, or carried on business, are as follows [specify place or places and period].

That I (or we) have no creditors who reside in any other place.

That my (or our) address for service is [specify].

That we are (or I am) the registered proprietor(s) of [full official description of land, including the area and title or index book reference; also the street or general locality in which the land is situated] (and of the following relative shares, namely, [specify particulars]).

That we (or I) at present (or will within 6 months of the date) reside and have our home in a dwellinghouse (or flat) erected on the said land.

That the said dwellinghouse (or flat) and land are (or will be within 6 months of the date) used exclusively as a home by us (or me) and the following members of our (or my) household, namely [state names and relationship], except to this extent, namely: [if the dwellinghouse and land are used exclusively for the above purposes, delete the words “except to this extent, namely”; if they are not used exclusively for the above purposes but, if it is submitted that they are used principally for these purposes, add, after the words “except to this extent, namely”, the other uses to which they are being put].

That we are (or I am) not the owner(s) of any other joint family home registered as such under the provisions of the Joint Family Homes Act 1964.

That we (or I) previously settled land as a joint family home in the [specify] Land Registration District under application number [specify] on [date].

That the land previously settled as a joint family home was disposed of on [date].

That the disposition of the land previously settled as a joint family home was for a fully adequate consideration in money or money’s worth payable to us (me).

That our (my) share(s) of the net proceeds of disposition have (has) not been intermingled with any other property, and have (has) been (or a sufficient equal part of each share has been) applied in or towards the acquisition of the land the subject of this application. [If one of the applicants is an undischarged bankrupt, then complete the following] And that I [specify], as an undischarged bankrupt, gave my share in the net proceeds of disposition to the Official Assignee forthwith after the date of the disposition.

That our (my) address for service is [specify].

That I have received the net proceeds of disposition due to [specify], the undischarged bankrupt.

That I invested the said proceeds in [specify] bank account.

That at the request of the undischarged bankrupt I have applied his/her share or a sufficient part thereof for the acquisition of the land in respect of which the above application is made.

you (or you and your wife or husband) reside, or one of you resides, in the dwellinghouse (or flat) to which the said application relates; and

the said dwellinghouse (or flat) and any land being settled therewith are being used exclusively or principally as a home for both or either of you and the members of your household—

We do not wish the property to continue to be owned by us in equal shares; and

We both consent to the property reverting to that one of us who was the sole owner prior to settlement [or] to both of us in the shares we held prior to settlement. [Delete the option not applicable]

We do not wish the proceeds to belong to us in equal shares; and

We both consent to the proceeds belonging to that one of us who was the sole owner prior to settlement [or] to us in proportion to the shares we held prior to settlement. [Delete the option not applicable]

Upon the settlement of a joint family home, the husband and the wife become owners of the property as joint tenants.

When the home is sold, transferred, or otherwise disposed of, or the settlement is cancelled, the proceeds of the property will be presumed to belong to the husband and wife in equal shares, unless the above notice of consent is signed by both parties.

The notice of consent may be signed—

The effect of both parties signing this notice is that the proceeds will belong, or the property will revert, to that spouse who was originally the sole owner or to the spouses in proportion to the shares held prior to settlement.