Quick Quote Questionnaires

When you have any reason to believe your client may not qualify for Preferred rates, completing a Quick Quote Questionnaire will enable you to intelligently question your client and develop information that an underwriter needs to evaluate your case. Fax to us and we'll quickly give you an accurate assessment on your case. No client signatures necessary.

For all life cases, start with our Pre-Underwriting Tool/Quick Fact Finder.


Medical Impairments

General
Cardiac / Heart Conditions
Cancer
Kidney Related

Non-medical Questionnaires


Authorization Form

The Authorization Form or Authorization Form 15-Point Type (required in CA) needs to be completed, signed and submitted to CPS in order to informally shop an impaired risk case. We have recently added a fillable PDF of the All States version that can be completed and printed right through your browser.

  • For cases with face amounts of $1 million and/or $5,000 estimated annualized premium and up, CPS will obtain the medical records upon receipt of the Informal Inquiry Form.
  • For cases with face amounts of $250,000 and/or estimated annualized premium of $1000 and up, please submit the medical records along with the Informal Inquiry Form.

Authorization Form (Fillable)