My dad sent this to me a while ago and I thought I’d share…


Application To Be Ill

This form must be submitted at least 21 days before the date on which you wish illness to commence.






Position Held


Date on which you wish your illness to commence


Consent of Husband/Wife YES/NO*


Have you ever applied to suffer from this illness before? YES/NO*


If so, give date(s)


Do you wish illness to be slight/severe/crippling/fatal*


If illness is fatal do you wish to be considered a permanent disability?

(applicants wishing to suffer a fatal illness should indicate at the foot of this form whether they wish the Area Health Authority to be represented at the funeral or cremation)


Do you wish to suffer the illness at home/hospital/Costa Brava/Newport Dagnell/Milton Keynes/Other*


Please indicate the approximate number of people you wish to infect?


Have you ever been refused permission to suffer from an illness? YES/NO*


If so, please give details


Do you wish your Wife/Husband to be informed of your illness if She/He contacted the area health authority regarding your whereabouts? YES/NO*


I the undersigned declare that to the best of my knowledge the answers given above are true and accurate.


Signed Date


Applicants are reminded that all applications will be considered on merit and that more than three applications per annum will be considered excessive, and not in the best interest of the National Health Service.


Under NO CIRCUMSTANCES will any employee be permitted to suffer more than ONE fatal illness, and any persons disregarding will render themselves liable for dismissal.



*Delete as appropriate.