Please use the checklist below to indicate the operation in the QBE Pacific Islands region to which you will be submitting your proposal. MARKET. 1. YOU must answer all questions giving full and complete answers. 2.It is YOUR duty to provide all information that is requested in the Proposal Form. Claim No. Date of Loss. Virginia State Corporation Commission must be written in the space provided on the Proposal Form. Business and Personal Bankruptcy. Collections. Roselle Center For Healing is your local Chiropractor in Fairfax, VA serving all of your needs. Call us today at (703) 698-7117 for an appointment!