Statement of Changes in Beneficial Ownership (4)
November 05 2019 - 4:13PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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0.5
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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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Lai John |
2. Issuer Name and Ticker or Trading Symbol
PetVivo Holdings, Inc.
[
PETV
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CEO
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(Last)
(First)
(Middle)
5251 EDINA INDUSTRIAL BLVD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/5/2018
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(Street)
EDINA, MN 55439
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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12/5/2018
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J
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259413
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D
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(1)
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2527188
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D
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Common Stock
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12/10/2018
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J
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600000
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A
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(2)
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3127188
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D
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Common Stock
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6/7/2019
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J
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175000
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D
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(3)
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2952188
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D
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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. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code (Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)
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8. Price of Derivative Security (Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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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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Common Stock Warrant
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$.50
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10/31/2019
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A
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600000
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12/31/2019
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10/31/2024
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Common Stock
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600000
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(4)
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1350000
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D
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Explanation of Responses:
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(1)
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During December of 2018 John Lai entered into several stock transfer agreements whereby he transferred, in aggregate, 259,413 shares of PetVivo common stock to several accredited investors to induce them into exercising their warrants.
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(2)
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John Lai retained 600,000 of his shares he offered up to be earned by another individual pursuant to an escrow agreement.
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(3)
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John Lai transferred 175,000 shares to a third-party pursuant to a settlement agreement he entered into in a private transaction.
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(4)
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John Lai was granted 600,000 warrants for purchase of 600,000 shares, whereby 400,000 are vested quarterly over 3 years and 200,000 are vested upon performance-based milestones. All 600,000 warrants have an exercise price of $.50 per share and a term of 5 years from the date of the grant.
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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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Lai John 5251 EDINA INDUSTRIAL BLVD EDINA, MN 55439
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X
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X
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CEO
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Signatures
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/s/ John Lai
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11/5/2019
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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 4(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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