Initial Statement of Beneficial Ownership (3)
October 11 2018 - 5:03PM
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
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Nissensohn Carlos Jaime
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2. Date of Event Requiring Statement (MM/DD/YYYY)
6/27/2018
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3. Issuer Name
and
Ticker or Trading Symbol
Quest Solution, Inc. [QUES]
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(Last)
(First)
(Middle)
TRAVESSA DA PRAIA 12B
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
PRAIA DA LUZ, S1 8600
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Warrant
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8/2/2017
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8/2/2020
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Common Stock
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1500000
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$0.11
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D
(1)
(2)
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Warrant
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3/8/2018
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3/8/2021
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Common Stock
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1000000
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$0.11
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D
(1)
(3)
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Explanation of Responses:
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(1)
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This Form 3 amendment is being filed to correct the original Form 3 filed on June 29, 2018. Table II of the original Form 3 incorrectly omitted Mr. Nissensohn's ownership of derivative securities of Quest Solution, Inc.
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(2)
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As disclosed in a Current Report on Form 8-k filed on August 04, 2017, Quest Solution, Inc. issued the warrants to Mr. Nissensohn on August 02, 2017. The issuance was pursuant to Mr. Nissensohn's consulting agreement with Quest Solution, Inc. dated August 02, 2017.
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(3)
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As disclosed in a Current Report on Form 8-k filed on March 12, 2018, Quest Solution, Inc. issued the warrants to Mr. Nissensohn on March 08, 2018. The issuance was pursuant to Mr. Nissensohn's consulting agreement with Quest Solution, Inc. dated August 02, 2017.
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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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Nissensohn Carlos Jaime
TRAVESSA DA PRAIA 12B
PRAIA DA LUZ, S1 8600
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X
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Signatures
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/S/ Carlos Jaime Nissensohn
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10/11/2018
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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 5(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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