Initial Statement of Beneficial Ownership (3)
August 25 2021 - 07:28PM
Edgar (US Regulatory)
|
FORM 3
|
UNITED STATES SECURITIES AND EXCHANGE
COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP
OF SECURITIES
|
OMB
APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response... 0.5 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
| 1. Name
and Address of Reporting Person * Smith Michael
Alan |
2. Date of Event Requiring Statement
(MM/DD/YYYY)
8/16/2021
|
3. Issuer Name and Ticker or Trading
Symbol Doma Holdings, Inc. [DOMA] |
|
(Last)
(First)
(Middle)
101 MISSION ST., SUITE 740 |
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
___X___ Officer (give title
below) _____
Other (specify below)
Chief Accounting Officer / |
|
(Street)
SAN
FRANCISCO, CA 94105
(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 |
Table I - Non-Derivative Securities Beneficially
Owned
|
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)
|
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 |
| Explanation of
Responses: |
Remarks:
Exhibit 24 - Power of Attorney |
| No securities are beneficially
owned. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Smith Michael Alan
101 MISSION ST.
SUITE 740
SAN FRANCISCO, CA 94105 |
|
|
Chief Accounting Officer |
|
Signatures
|
|
Christian Ameri, as Attorney-in-Fact for Michael
Alan Smith |
|
8/25/2021 |
| **Signature
of Reporting Person |
Date |
Capitol Investment Corp V (NYSE:CAP)
Historical Stock Chart
From Apr 2022 to May 2022
Capitol Investment Corp V (NYSE:CAP)
Historical Stock Chart
From May 2021 to May 2022
