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<text><![CDATA[ระวาง...........................................................................]]></text>
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<text><![CDATA[ตำบล.............................................................................]]></text>
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<text><![CDATA[ตำแหน่งที่ดิน]]></text>
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<text><![CDATA[ ๑)ข้าพเจ้าผู้มีนามต่อไปนี้มีความประสงค์ขอจดทะเบียนสิทธิและนิติกรรมเกี่ยวกับอสังหาริมทรัพย์ที่กล่าวข้างบนนี้และได้ปฎิญาณตน]]></text>
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