Name of Boyfriend/Fiancé/Husband:

I request permission for a leave of absence from the highest authority in my life for the following period:

Date: Time of departure: Time of return NOT to exceed:

Should permission be granted, I do solemnly swear to only visit the locations stated below, at the stated times. I agree to refrain from hitting on or flirting with other women. I shall not even speak to another female, except as expressly permitted in writing below. I will not turn off my mobile after two pints, nor shall I consume above the allowed volume of alcohol without first phoning for a taxi AND calling you for a verbal waiver of said alcohol allowance. I understand that even if permission is granted to go out, my girlfriend/fiancé/wife retains the right to be pissed off with me the following week for no valid reason whatsoever.

Amount of alcohol allowed (units): Beer Wine Liquor Total

Locations to be visited:

Females with whom conversation is permitted:

IMPORTANT – STRIPPER CLAUSE: Notwithstanding the female contact permitted above, I promise to refrain from coming within one hundred (100) feet of a stripper or exotic dancer. Violation of this Stripper Clause shall be grounds for immediate termination of the relationship.

I acknowledge my position in life. I know who wears the trousers in our relationship, and I agree it’s not me. I promise to abide by your rules & regulations. I understand that this is going to cost me a fortune in chocolates & flowers. You reserve the right to obtain and use my credit cards whenever you wish to do so. I hereby promise to take you on an unlimited shopping spree, should I not return home by the approved time. On my way home, I will not pick a fight with any stranger, nor shall I conduct in depth discussions with the said entity. Upon my return home, I promise not to urinate anywhere other than in the toilet. In addition, I will refrain from waking you up, breathing my vile breath in your face, and attempting to breed like a (drunken) rabbit.

I declare that to the best of my knowledge (of which I have none compared to my BETTER half), the above information is correct.

Signed - Boyfriend/Fiancé/Husband:

Request is: APPROVED / DENIED

This decision is not negotiable. If approved, cut permission slip below and carry at all times.

…………………………………………………………………………………………………………..

Permission for my boyfriend/fiancé/husband to be away for the following period of time:

Date: Time of departure: Time of return:

Signed – Girlfriend/Fiancé/Wife: