Usually you would just be asked for a name and address. British addresses are longer than in Germany. But on a form the layout might be something like this:

Name
House name/number
Road
Town
County
Postcode

You would normally just put your signature and the date at the bottom.

I've never seen 'Ort' on a form originating from the UK!

If you do have to translate it, I suggest: town/city

Vielleicht habe ich mich nicht deutlich ausgedrückt.

Es geht um einen Brief/eine Vereinbarung, also:

"Vereinbarung zwischen X& Y
Hiermit wird vereinbart, dass ....
Weiterhin besteht Einvernehmen darüber, dass...
Beide Parteien verpflichten sich ....
etc pp

Ort: Sowiesostadt
Datum X.XX.XXXX
Unterschrift: XY"

Especially in contracts the personal signature is often preceded by the name of the town where it is signed and the date of signature e.g.

Hamburg den 1.1.2005 Signature

Especially in letters it is often sufficient to include only the date of signature (i.e. if the letter is not personal, in personal correspondence you would include neither)

You can simply say:

Signed in (Stadt), on April 6, 2005.
Signature

Possibly underline the location and date

Sorry, I went a bit over the top!
I would agree with the other suggestions: place, date, signature.

or:

Signed ...<NAME>... in ...<PLACE>... dated ...<DATE>...

Except in specific cases: at – When designating a figure for a specific date, use of at rather than on is standard financial reporting usage in the U.S. Example: At September 30, 2004, Big INC. employed 200,000 people worldwide.