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R block. Complete all required fields and remember to sign the form. 2. This form may be posted, faxed or emailed to WealthNet head office. It may also be handed in at any WealthNet branch. 1. BASIC PRODUCT - Principal Member - R10 000 Funeral Benefit PLUS a R5 000 Beef Benefit PRINCIPAL MEMBER (under age 65; see benefits on overleaf) Client Number 1 x R35 (A) R 3 5 WealthNet Membership Number Title First Names Surname ID Number Date of birth Tel (W) d d / Tel (H) m m / y.

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