Poetry Insurance

Blake and Owen have a proud history of having insured great writers.
“What's done cannot be undone.”
by William Shakespeare, in Macbeth
Was originally, “What’s done cannot be unzipped.”
 “A thing of beauty is a joy forever.“
John Keats 
Was originally written : “ A thing sitting pretty is a joy forever”
Dylan Thomas’s line,
 “Do not go gentle into that good night/Rage, rage against the dying of the light.”
“No man is an island.”
Was originally,
“Do not go gently into that good night tiff, rage against the dying of the light bulb”
This titular line by John Donne
“Better to reign in Hell than serve in Heaven.”
from Milton’s Paradise Lost
Was originally,
“Better to reign in Hell than to serve at Macdonald’s”
 “Things fall apart; the centre cannot hold.“
By W.B. Yeats The Second Coming,
Was originally
“Things fall apart; the day care center cannot hold”
“The time has come, the Walrus said / To talk of many things.“
from Lewis Carroll’s Alice’s Adventures in Wonderland 
Was originally,
“The time has come, the eager Walrus said/ To shoot the breeze.”

Blake Owen & Republic Best Fire Insurance for Poetry 
Recipient of the Indian Insurance Award 1887
DETAILS OF PRIMARY INSURED

1. a)  Policy Name:: Radiant Elephant Poetry Insurance
   
   

4. d)  Name:
   
5. e)  Address
   

Claim Form-Part A
To be filled in by the insured
The issue of this Form is not to be taken in as admission of liability
(To be filled in block letters)
(SECTION A)
Middlename
(SECTION B)
Surname
First name
DETAILS OF POETIC HISTORY

a) Have you been hospitalized in the last four years for a poem? Yes No
Date: D D M M Y Y Y Y
c) Explain the incident:
d) Has your poem ever gotten too hot?
iii Do you keep a fire extinguisher 20 feet from readings?

5. e)  Previously covered by any other Poetry/Health Insurance
   
6. f)  If yes, Company Name:
   

DETAILS OF INSURED PERSON HOSPITALIZED
(SECTION C)
Middle name
Diagnosis: Yes No Don't Know
Surname Male Female c) Age: Years Y Y
DETAILS OF HOSPITALIZATION
a) Name of Hospital where Admitted:
(SECTION D)
b) Room Category occupied: Day Care 3 Poems per Day
Twin sharing 5 or more beds per room
M M Y Y Y Y f) Time: H H M M
 Illness: a) aembic pentameter b) false metaphor - first detected
c) Hospitalizaton due to: poetry stress b) receiving stones from audience  e) other
DateofAdmission: D D M M Y Y Y Y
g) DateofDischarge:

9. j)  System of Treatment recommended: “Barney: I love you, you love me"
   

(SECTION E)
ii) Recital Expenses iv) Blood Pressure before and after reading 
Cost vi) Other(Code)
Yes
No
viii) Post-Poetry hospitalization period  (If yes, provide details in annexure)

2. Poetry Surgery: 200%
   
3. implant of simile 400%
   
4. implant of alliteration 300%
   
5. Poetry SPA with thermal water 400%
   
6. Speech coaching in Poem Booth 200%
   
   

Doctor’s request for Poetic investigation
(Including CT/MRI/USG/HPE)



Include bills from Poetry Accident
1.
4.
5.

DETAILS OF BANK ACCOUNT



Account Number:



DECLARATION BY THE INSURED (SECTION H)
I hereby declare that the information furnished in this Claim From is true & correct to the best of my knowledge and belief. If I have made any false or untrue statement, any poem written herewithin to this claim in poor verse, my right to claim reimbursement shall be forfeited.
I hereby declare that I have included all the bills/ receipts for the purpose that my treatment of my poetry injury of this claim & that I will not be making any supplementary claim except a slip in alliteration that may impact my pre/post-hospitalization claim, if any.
Date: Place: Signature of the
Insured

D

D

M

M

Y

Y

Y

Y

Signature: ____________________