Initial Statement of Beneficial Ownership (3)
March 24 2021 - 6:05AM
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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Hughes Michael Forrest |
2. Date of Event Requiring Statement (MM/DD/YYYY)
3/9/2021
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3. Issuer Name and Ticker or Trading Symbol
Mawson Infrastructure Group Inc. [WIZP]
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(Last)
(First)
(Middle)
C/O WIZE PHARMA, INC., LEVEL 5, 97 PACIFIC HIGHWAY |
4. 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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(Street)
NORTH SYDNEY, C3 2060
(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) |
Common Stock | 16072 | D | |
Common Stock | 3579335 | I | By spouse |
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 |
8% Convertible Note | (1) | (2) | Common Stock | 227139 | $0.339 | I | By Roscommon Capital Pty Ltd as trustee for the Michael Hughes Family Trust |
Explanation of Responses: |
(1) | The earlier of (a) August 12, 2021; and (b) the admission of the Issuer's shares to quotation on the NASDAQ Stock Market. |
(2) | The 8% Convertible Note is required to be repaid on earliest of: (a) a trustee, receiver or other custodian is appointed for the Issuer, or the Issuer makes a general assignment for the benefit of its creditors; (b) the Issuer files for bankruptcy (c) an involuntary petition is filed against the Issuer (unless such petition is dismissed or discharged within 60 days under any bankruptcy statute now or hereafter in effect or a custodian, receiver, trustee, assignee for the benefit of creditors (or other similar official) is appointed to take possession, custody or control of any property of the Issuer; or (d) the Issuer resolves to dissolve. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Hughes Michael Forrest C/O WIZE PHARMA, INC. LEVEL 5, 97 PACIFIC HIGHWAY NORTH SYDNEY, C3 2060 | X |
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Signatures
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/s/ Michael Forrest Hughes | | 3/24/2021 |
**Signature of Reporting Person | Date |