SEC Form 4 · accession 0001580695-18-000576
Petrolia Energy Corp · BBLS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Richard D Dole
Director
Period of report
Nov 13, 2018
Accepted (ET)
Dec 28, 2018 · 7:16 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001368637
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Nov 13, 2018 | A | 312,500 | $0.08 | A | 812,500 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrants to Purchase Common StockF1 | $0.10 | Nov 13, 2018 | A | 625,000 | A | Nov 13, 2018 | Nov 13, 2020 | Common Stock | 625,000 | 625,000 | D |
Explanation of responses
- F1Mr. Dole participated in the Issuer's Private Placement #4, acquiring securities for a purchase price of $0.08/share. Participants also received 2x warrants for every share purchased, exercisable for 2 years. Exempt pursuant to Rule 16b3(d).