Initial Statement of Beneficial Ownership (3)
November 29 2019 - 5:44PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Borene Andrew |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/26/2019
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3. Issuer Name and Ticker or Trading Symbol
CIPHERLOC Corp [CLOK]
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(Last)
(First)
(Middle)
C/O CIPHERLOC CORPORATION, 825 MAIN STREET, SUITE 100 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) Chief Executive Officer / |
(Street)
BUDA, TX 78610
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Options (right to buy) | (1) | 11/26/2029 | Common Stock | 500000 | $0.75 | D | |
Explanation of Responses: |
(1) | The stock options vest over three years in equal annual installments beginning on November 26, 2020 (166,666 options on November 26, 2020; 166,667 options on November 26, 2021; and 166,667 options on November 26, 2022). |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Borene Andrew C/O CIPHERLOC CORPORATION 825 MAIN STREET, SUITE 100 BUDA, TX 78610 |
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| Chief Executive Officer |
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Signatures
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/s/ Andrew Borene | | 11/29/2019 |
**Signature of Reporting Person | Date |
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