Application to record or amend a security interest

Use this form to tell us about the grant or amendment of any security interest over a registered trade mark.



This file may not be suitable for users of assistive technology. Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email Please tell us what format you need. It will help us if you say what assistive technology you use.


Note: The grantor or their recorded representative must sign section 7 of this form. If you cannot do this, you should send us written proof of the transaction.

Fee sheet

Fee payable forms must be accompanied with a completed fee sheet.



Published 16 April 2013