I would like to thank Carol Sage for sharing this wartime joke with us.
In 1940 you probably had to fill in a form to apply for just about anything – and in triplicate of course! So this was a topical joke of the time, something to cause a smile and keep up spirits.
In 1940 Carol′s mother had just completed a course in shorthand and typing, and she got a job working in Kent County Council′s Public Assistance Department in Bouverie Square. She also worked as an ARP volunteer. The staff in the Public Assistance Office produced the spoof application form as an in–house joke.
When born and Why __________________________________________
1) I hereby make application to be ill. (Permit)
2) I declare
(a)That I have a pain in my (i) head (ii) stomach (iii) chest
(iv) arm (v)_______
(b)That my complexion is (i) ruddy (ii) pallid (iii) green
(c)That I have broken my (i) arm (ii) leg (iii) neck
(d)That during the last 12 hours I have been sick __ times
(e)That I expect to be sick again in ___ Hours.mins/secs
(f)That I am afraid I will (i) die (ii) not die (iii) live
(iv) not live
(g)That I am off my (i) food (ii) drink (iii) head
3) The name of my Doctor is ______________ or the name of
my veterinary surgen is ______
4) I have been taking (i) salts (ii) pills (iii) tablets
5) I am (i) in bed (ii) in pain (iii) in desperation (iv) in my coffin
6) What is the effect of a dose of Cascara? _______ How
7) I can see (i) spots (ii) nothing (iii) animals. If animals
state what type and colour_____________
8) I have spots on my _________ (a) They do/do not itch.
(b) I am/am not scratching them.
9) I am/am not pregnant. In case of male patients further
details should be given on a separate sheet. Blankets should
not be used.
10) I am (i) depressed (ii) elated (iii) about to shoot myself
Note. in this case a Firearm Certificate is required.
11) I would be willing to take (i) medicine (ii) treatment
(iii) medicine and treatment (iv) treatment and medicine
12) I request admission to (i) hospital (ii) asylum (iii) mortuary
13) I request the services of a (i) doctor (ii) midwife (iii) nurse
(State whether day, night, dry, blonde, brunette, young/and or
14) I believe my complaint to be________________________
in case a permit cannot be issued for this complaint would you
be willing to accept another illness, malady, disease? State
Yes or No ____________.
This form when completed should be submitted in triplicate to
the Local health Officer. Should the applicant die before
the permits is issued, the Local Health Officer should be notified
and a new application for a permit to be declared dead (Form R.I.P.)
should be submitted by a relative or creditor.
Permits are not transferable, but a permit for a common cold
may be used by all members of the applicant′s family, provided
that all the colds, up to a maximum of six, are caught within 14 days
of the date of issue.
I declare that all the above answers are true/as true as those
on my Petrol Application.
Signature ___________ Date______________