Amended Statement of Beneficial Ownership (sc 13d/a)
December 18 2018 - 5:03PM
Edgar (US Regulatory)
UNITED
STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE
13D
Under
the Securities Exchange Act of 1934
(Amendment
No. 2)
DOCUMENT
SECURITY SYSTEMS, INC.
|
(Name
of Issuer)
|
Common
Stock, par value $0.02 per share
|
(Title
of Class of Securities)
|
Jeffrey
D’Angelo, Vice President, General Counsel
Document
Security Systems, Inc.
200
Canal View Blvd., Suite 300
Rochester,
New York 14623
with
copy to:
Alexander
M. Donaldson
Wyrick
Robbins Yates & Ponton LLP
4101
Lake Boone Trail, Suite 300
Raleigh,
North Carolina 27607
Telephone:
(919) 781-4000
|
(Name,
Address and Telephone Number of Person Authorized to Receive Notices and Communications)
|
December
17, 2018
|
(Date
of Event which Requires Filing of this Statement)
|
If
the filing person has previously filed a statement on Schedule 13G to report the acquisition that is the subject of this Schedule
13D, and is filing this schedule because of 240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box [ ].
Note:
Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See 240.13d-7(b)
for other parties to whom copies are to be sent.
*The
remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the
subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in
a prior cover page.
The
information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section
18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the Notes).
CUSIP
No. 25614T200
Page
2 of 4
SCHEDULE
13D
1
|
NAMES
OF REPORTING PERSONS
I.R.S.
IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Heng
Fai Ambrose Chan
|
2
|
CHECK
THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a)
[ ]
(b)
[ ]
|
3
|
SEC
USE ONLY
|
4
|
SOURCE
OF FUNDS (See Instructions)
AF
and PF
|
5
|
CHECK
IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(D) OR 2(E)
[ ]
|
6
|
CITIZENSHIP
OR PLACE OF ORGANIZATION
Republic
of Singapore
|
NUMBER
OF
SHARES
BENEFICIALLY
OWNED
BY
EACH
REPORTING
PERSON
WITH
|
7
|
SOLE
VOTING POWER
2,972,443
(1)
|
8
|
SHARED
VOTING POWER
|
9
|
SOLE
DISPOSITIVE POWER
2,972,443
(1)
|
10
|
SHARED
DISPOSITIVE POWER
|
11
|
AGGREGATE
AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
2,972,443
(1)
|
12
|
CHECK
BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (See Instructions)
[ ]
|
13
|
PERCENT
OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
17.06%
(2)
|
14
|
TYPE
OF REPORTING PERSON (See Instructions)
IN
|
1
Consists
of (a) 1,786,531 shares of common stock, par value $0.02 per share of Document Security Systems, Inc. (the “
Common Stock
”)
held by Heng Fai Holdings Limited (“
Heng Fai Holdings
”), (b) 500,000 shares of Common Stock held by BMI Capital
Partners International Limited (“
BMI Capital
”), (c) 683,000 shares of Common Stock held by Hengfai Business
Development Pte Ltd. (“
Hengfai Business Development
”), and (d) 2,912 shares of Common Stock held by the Reporting
Person.
2
Based on 17,425,858
shares of Common Stock outstanding as of December 17, 2018.
CUSIP
No. 25614T200
Page
3 of 4
This
Amendment No. 2 on Schedule 13D amends the statement on Schedule 13D, filed with the SEC on September 15, 2017, as amended by
Amendment No. 1, filed with the SEC on July 6, 2018 (the “
Amended Original Schedule 13D
”), which relates to
the Common Stock of the Issuer filed by Heng Fai Ambrose Chan (the “
Reporting Person
”). Except as previously
amended and expressly amended below, Amended Original Schedule 13D remains in effect and capitalized terms not defined herein
are defined in the Amended Original Schedule 13D.
Item
4.
|
Purpose
of Transaction
|
The
Reporting Person is in the process of identifying individuals to potentially serve as directors of the Issuer.
The
Reporting Person has increased his ownership in the Issuer and may add to his holdings of the Issuer’s common stock in the
future.
Item
5.
|
Interest
in Securities of the Issuer
|
|
(a)
|
Personal
ownership by reporting person Heng Fai Ambrose Chan: 2,912 shares of Issuer’s common stock, par value $0.02 per share.
|
|
|
|
|
|
Ownership
by affiliate Heng Fai Holdings Limited: 1,786,531 shares of Issuer’s common stock, par value $0.02 per share.
|
|
|
|
|
|
Ownership
by affiliate BMI Capital Partners International Limited: 500,000 shares of Issuer’s common stock, par value $0.02 per
share.
|
|
|
|
|
|
Ownership
by affiliate Hengfai Business Development Pte. Ltd.: 683,000 shares of Issuer’s common stock, par value $0.02 per share.
|
|
|
|
|
(c)
|
Each
of the transactions described in this 5(c) were reported on Forms 4 filed by the Reporting Person filed with the SEC
pursuant to Section 16 of the Act and are available on the SEC’s website at www.sec.gov. The information reported in such
filing is expressly incorporated herein.
|
CUSIP
No. 25614T200
Page
4 of 4
Signature
After
reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true,
complete and correct.
12/18/2018
|
|
Dated
|
|
|
|
/s/
Heng Fai Ambrose Chan
|
|
Signature
|
|
|
|
Heng
Fai Ambrose Chan
|
|
Name
|
|
The
original statement shall be signed by each person on whose behalf the statement is filed or his authorized representative. If
the statement is signed on behalf of a person by his authorized representative (other than an executive officer or general partner
of this filing person), evidence of the representative’s authority to sign on behalf of such person shall be filed with
the statement, provided, however, that a power of attorney for this purpose which is already on file with the Commission may be
incorporated by reference. The name and any title of each person who signs the statement shall be typed or printed beneath his
signature.
Attention:
Intentional misstatements or omissions of fact constitute Federal criminal violations (See 18 U.S.C. 1001).
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