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  Customer Referral Form

Dear Customer,
Thank you for your interest in filling in our Customer Referral form. Please read the "Definitions" and the "Terms and Condition" sections below. 
1.What is your full name?(Required.)
2.What is your contact number?(Required.)
3.What is your e-mail address?
4.Are you currently a Guardian Life customer?
5.Would you be interested in keeping up to date with our products & services?
6.What is the full name of the person you are referring?(Required.)
7.What is their Date of Birth?*(Required.)
8.What is their contact number?(Required.)
9.What is their e-mail address?
10.What products are they interested in? Select all that applies.  
11.Can we contact you to offer other products and services? 
12.Please state the name of your agent.
13.Please state the name of the branch to which the agent belongs.
Definitions

In this Agreement the following expressions will have the following meanings:

(a) “Client” means any person who is a policy owner of the Company;

(b) “Rewards” means vouchers/coupons gifted by the Company to the referrer on confirmation of a successful referral.

(c) “Successful” means the lead has been converted and the referee has purchased a Guardian Life policy

(d) “Converted” means referral has moved from the stage of consultation with agent, to purchase of a policy

Terms & Conditions

This program is available to clients of Guardian Life of The Caribbean Limited (GLOC). Users who refer others to the program are "Referrers"; those who are referred are "Referred Customers." Referrers are eligible to receive "rewards" for every successful referral.

To qualify for a reward, referrers must complete the referral process by completing the form through SurveyMonkey (https://www.surveymonkey.com/r/6667F2F). To qualify for a reward, the referral MUST be successful. All referrals are subject to review by Guardian Life of The Caribbean Limited to determine eligibility. Guardian Life of The Caribbean Limited reserves the right to review and confirm eligibility of each referral. Should the referral not be converted or successful, the referrer will NOT be rewarded. Guardian Life of The Caribbean Limited also reserves the right to deny rewards, should the referral not be confirmed as successful upon review. You may refer as many persons as you like. Upon confirmation of a successful referral, referrers are eligible to be rewarded on behalf of the agent. Rewards are subject to availability, and will be chosen randomly, from a list of preapproved local merchants.

Privacy

By clicking on the referral link and completion of the form, the referrer acknowledges some of their personal information as well as the referred customer’s personal information will be sent to Guardian Life of The Caribbean Limited. Any personal information collected, reviewed and processed, will be held in confidentiality.