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: 

Location:   From: To: 

Beer Wine Liquor:   Total

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 fed up with me the following week for no valid reason whatsoever.

Amount of alcohol allowed (units) Beer 
Locations to be visited 
Females with whom conversation is permitted

IMPORTANT – STRIPPER CLAUSE: Not withstanding 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 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.  

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