Statement of Changes in Beneficial Ownership (4)
May 22 2020 - 9:58AM
Edgar (US Regulatory)
FORM 4
[X]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
ROFF DAVID |
2. Issuer Name and Ticker or Trading Symbol
DEEP WELL OIL & GAS INC
[
DWOG
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner _____ Officer (give title below) __X__ Other (specify below) See footnotes. |
(Last)
(First)
(Middle)
27 CHICORA AVENUE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/14/2020 |
(Street)
TORONTO, A6 M5R 1T7
(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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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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (Expired) | $0.38 | 9/19/2019 | | J | | | 600000 (1) | (2) | 9/19/2019 | Common Stock | 600000 (1) | $0.38 | 0 (2) | D | |
Explanation of Responses: |
(1) | As of May 14, 2020, Mr. David Roff resigned as a director of the Issuer and is no longer subject to section 16 reporting requirements. As of May 14, 2020, the Reporting Person beneficially owns 848,155 shares (Non-Derivative Securities) of the Issuer's common stock of which shares are held directly. Mr. Roff has no Derivative Securities as reported in Table II above. |
(2) | On September 19, 2014, the Issuer's Board granted Mr. David Roff, options to purchase 600,000 shares each of common stock at an exercise price of $0.38 per common share, with one-third vesting immediately, one-third vesting on September 19, 2015, and one-third vesting on September 19, 2016, each with a five-year life from the original grant date. These options have since expired unexercised. This transaction was previously reported on Form 4 and filed with the U.S. Securities and Exchange Commission on September 20, 2019. The purpose of this Form 4 is to disclose that Mr. David Roff is no longer subject to section 16 reporting requirements and that the transaction reported is not new or revised but is being reported again to gain access to the system to file Mr. Roff's final Form 4. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
ROFF DAVID 27 CHICORA AVENUE TORONTO, A6 M5R 1T7 |
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| See footnotes. |
Signatures
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/s/ David Roff | | 5/20/2020 |
**Signature of Reporting Person | Date |