- 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
- -
