Contact your CSR at CPS-Reliable for assistance with your Impaired Risk cases.

An evaluation for life… usually in 48 hours, or less. The Quick Quote Questionnaire asks all the pertinent questions as to the condition or ailment of the applicant – permitting our participating companies the opportunity of evaluating the information and making a tentative offer for life insurance for the client. No signatures, no application, no time consuming investigations or expensive Attending Physicians’ Statements - a complete evaluation in less than 48 hours. All questions must be completed.

All Forms are to be faxed to CPS-Reliable.
National Toll Free Fax Number is 1 (877) 921-1755

Alcohol and Drug Usage	Hypertension
Build	Kidney Transplant
Cancer, all types	Multiple Sclerosis
Cardiovascular Accident / Stroke	Other Illness
Chronic Lymphocytic Leukemia	Paralysis / Spinal Cord Injury
Coronary Angioplasty	Parkinson’s Disease
Coronary Bypass	Preferred Risk Factors
Depression	Pulmonary Disease
Diabetes	Rheumatoid Arthritis
Driving Violations	Sarcoidosis
Heart Attack / Myocardial Infarction	Sleep Apnea
Heart Conditions	Systemic Lupus Erythematosus
Hepatitis and Elevated Liver Functions	Ulcerative Colitis / Crohn’s Disease

Contact your local RFG office for assistance with your Impaired Risk cases.

The Informal Inquiry Form or Informal Inquiry 15-Point Type (required in CA) needs to be completed, signed and submitted to CPS when APS(s) need to be acquired prior to shopping an impaired risk case.

In order to shop cases ALL information requested on the Informal Inquiry Check List - Click Here - will need to be submitted with the Informal Inquiry. Missing Information will result in case not being processed.

On occasion, a carrier will require that a questionnaire be completed during the underwriting of a case. THESE ARE NOT THE SAME AS QUICK QUOTE QUESTIONNAIRES. It may be necessary to complete one of the standard forms for submission with an application. Click on the questionnaire you would like to view or print out.

Alcohol Usage	Confidential Financials	Resident Alien
Aviation	Coronary	Seizures
Business Insurance	Diabetes	Substance Usage
Chest Pain	Foreign Residence	Tobacco Usage
Climbing	Racing	Underwater and Sky Sports

All Forms are to be faxed to CPS-Reliable.
National Toll Free Fax Number is 1 (877) 921-1755