SEC Form 4 · accession 0001144204-19-001529

DOCUSIGN, INC. · DOCU

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Jan 10, 2019

Accepted (ET)

Jan 14, 2019 · 11:56 am EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001261333

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F2	Jan 10, 2019	J	77,998	$0.00	D	15,700	I	See Footnote
Common Stock^F4	Jan 10, 2019	J	41,553	$0.00	A	165,819	D

No Table II lines on this filing.

F1Represents a pro-rata in-kind distribution of Common Stock of the Issuer by KPCB DGF Associates, LLC ("DGF Associates") without consideration to its members (the "DGF Associates Distribution"). The reporting person is a managing member of DGF Associates and may be deemed to share voting and investment power over the securities held by DGF Associates. The reporting person disclaims beneficial ownership over such securities except to the extent of her pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
F2The shares are held directly by DGF Associates. The reporting person is a managing member of DGF Associates and may be deemed to share voting and investment power over the securities held by DGF Associates. The reporting person disclaims beneficial ownership over such securities except to the extent of her pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
F3Represents a change in the form of ownership from indirect to direct by virtue of the receipt of shares in the DGF Associates Distribution.
F4Shares are held directly by the reporting person.