Refer a friend and get a chance to win $100,000

By filling up this form, you agree that we can use your personal information when contacting the person you have referred. Once you submit the form, the person you referred will receive a call within 2-3 days from one of our staff to obtain more information to asses whether they are in a position to move forward.

Please provide the contact details of the PERSON YOU ARE REFERRING

1 qualified referral = 1 entry


(If you are referring a couple this is counted as 1 entry)

Your Details





You must read and accept the privacy disclaimer and terms and conditions before you can continue

Privacy Disclaimer: Your information is confidential and remains with 21st Century Group and will never be passed on to a 3rd party unless specifically requested by you in writing. See full Privacy Policy

I have read and understand the Terms and Conditions.