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If a policyholder chooses to reject PIP insurance, she must do so:

  1. in writing

  2. every time the policy is renewed or amended

  3. before paying any premiums

  4. within 10 days of receiving the insurer's offer

The correct answer is: in writing

A policyholder must reject PIP insurance in writing in order for it to be considered valid. Option B is incorrect because the policyholder only needs to reject PIP insurance once, not every time the policy is renewed or amended. Option C is incorrect because the policyholder can reject PIP insurance at any time, not necessarily before paying any premiums. Option D is incorrect because there is no timeframe given for when the policyholder must reject PIP insurance, only that it must be done in writing. So, option A is the only correct answer as it states the specific way in which PIP insurance must be rejected in order to be valid.