Referral Form

After completing the Referral Form, we will have someone in touch with you shortly, and we will regularly send you the latest product and promotion information.

Please fill in the information in Chinese *Required fields

Service Plan Selection

Applicant's Information

Surename*

Given name*

Contact Phone Number*

Email Address

Relationship with User (if form filling person not the user)

Name of Referral Company

User's Information

Surname*

Given Name*

Contact Number*

Home Address

The Elderly Housing Association reserves the right to use the above personal information to contact the person filling the form.

I read and agree to the above terms.