- Date of agreement
- —
- Place of signing
- —
- Owner of dominant (benefiting) land - full name
- —
- Dominant owner - nationality
- —
- Dominant owner - ID type
- —
- Dominant owner - ID/passport number
- —
- Dominant owner - passport expiry date
- —
- Dominant owner - date of birth
- —
- Dominant owner - registered address
- —
- Dominant owner - marital status
- —
- Dominant land - title deed (chanote) number
- —
- Dominant land - parcel/land number (เลขที่ดิน)
- —
- Dominant land - location (sub-district/district/province)
- —
- Owner of servient (burdened) land - full name
- —
- Servient owner - nationality
- —
- Servient owner - ID type
- —
- Servient owner - ID/passport number
- —
- Servient owner - passport expiry date
- —
- Servient owner - date of birth
- —
- Servient owner - registered address
- —
- Servient owner - marital status
- —
- Servient owner - spouse consent (name + signature line)
- —
- Servient land - title deed (chanote) number
- —
- Servient land - parcel/land number (เลขที่ดิน)
- —
- Servient land - survey/dealing page no (หน้าสำรวจ)
- —
- Servient land - location (sub-district/district/province)
- —
- Servient land - total area (rai-ngan-wah)
- —
- Servitude type
- —
- Burdened strip - location, width & area on servient land
- —
- Duration
- —
- Fixed term - number of years (if fixed term)
- —
- Consideration basis
- —
- Consideration amount (if for value)
- —
- Consideration currency
- —
- Land Office of registration
- —
- Who pays registration fees
- —
- Witness 1 - full name
- —
- Witness 2 - full name
- —
