This form can be filled out online. The Supplemental Instructions (PDF) provide guidance for completing the OMBapproved Part A NMSN form.Please review these instructions as you complete the enclosed Claimant Statement. If you need any assistance, please call us, toll-free at (800) 221-2554. Some of the forms below are fillable forms, which means you can type your answers directly on the form. To fill out the form: 1. , out-of-network doctors and hospitals). Your policy provides Personal Injury Protection benefits, including property damage liability, which are required to be provided under Florida law. Frequently Asked Questions. Do you have a question about being an insurance agent in Florida?