The first page contains detailed information about PIP coverage, tells you how the form is arranged and provides definitions of some key terms used in the form. The purpose of this form is to explain the choice you have regarding your Personal Injury.How do I fill this out? Please use the checklist below to indicate the operation in the QBE Pacific Islands region to which you will be submitting your proposal. MARKET. Policy Period End Date. 10. This form guides users in selecting Personal Injury Protection (PIP) medical coverage for commercial auto policies in Michigan. 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.