| Role | Name | Name (original language) | Name (translation) | Floruits |
|---|---|---|---|---|
| Addressor | Innocent III, pope (d.1216) | Innocentius | Innocent, bishop, servant of servants of God | 1198 × 1216 |
| Beneficiary | Hospital of St John of Jerusalem | fratribus [document damaged] | brethren [of Hospital of Jerusalem] | 1162 × 1250 |