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Purple Underwriters, Inc. P.O. Box 998 Portland, ME 04104 (800) 4411799 FAX: (207) 8560260 Public Application COLUMBIA INSURANCE COMPANY NATIONAL FIRE & MARINE INSURANCE COMPANY NATIONAL INDEMNITY
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This form is a tax document related to public auto insurance policies.
Insurance companies and policyholders are required to file this form.
The form must be completed with information about the insurance policy and any claims made.
The purpose of this form is to report information about public auto insurance policies.
Information such as policy details, claims history, and coverage amounts must be reported.
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