No. If employed, state your current employer. 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. A claim form may be obtained at the address or following telephone number, . (i) When filling in this Form, please see that all the questions are fully answered. Bid proposals must be written in ink or typewritten and shall be submitted on the forms issued. Unsigned or qualified bids will not be accepted. This document contains a nomination form for life insurance and personal accident insurance.