Statement of Changes in Beneficial Ownership (4)
June 25 2015 - 11:41AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
DAS SATYA BRATA
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2. Issuer Name
and
Ticker or Trading Symbol
DEEP WELL OIL & GAS INC
[
DWOG
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
SUITE 710, 10150 - 100 STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
6/19/2015
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(Street)
EDMONTON, A0 T5J 0P6
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Shares
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6/19/2015
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J
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120714
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D
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$0.04
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1221667
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I
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See foot note
(1)
(2)
(3)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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On June 19, 2015, Cambridge Strategies Inc., by way of a board resolution and irrevocable stock power form, transferred out 120,714 shares of common stock to its former partner Mr. Ken J. Chapman (Mr. Ken J. Chapman's portion of the November 9, 2010 private placement shares).
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(
2)
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Effective on November 9, 2010, Cambridge Strategies Inc. closed a private placement with the Issuer for an aggregate of 714,285 units at a price of US$0.07 per unit, for total gross proceeds of US$50,000. Each unit is comprised of one restricted common share and one common share purchase warrant. The value of each restricted common share was US$0.04 cents at the time. At the time of this private placement Cambridge Strategies Inc. was 50% owned by Mr. Ken J. Chapman, 25% by Mr. Satya Brata Das and 25% owned by Mr. Satya Brata Das' wife.
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(
3)
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Cambridge Strategies Inc. is a company now owned 50% by Mr. Satya Brata Das and 50% owned by his wife.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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DAS SATYA BRATA
SUITE 710, 10150 - 100 STREET
EDMONTON, A0 T5J 0P6
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X
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Signatures
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/s/ Satya Brata Das
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6/24/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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