SEC Form 5 · accession 0001594062-16-000396
Rafina Innovations Inc. · VICA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Heleen Francoise Kist
Officer — Chief Operating Officer
Period of report
Dec 31, 2015
Accepted (ET)
Mar 7, 2016 · 11:42 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001402737
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common stockF1 | Dec 1, 2015 | G | 720,000 | $0.00 | A | 1,420,000 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Shares acquired were a bona fide gift received on December 1, 2015. There was no consideration paid by the Reporting Person.
Remarks
All share numbers and per share prices disclosed on this Form 4 give effect to the Issuer's seven-for-one (7 for 1) forward stock split completed on August 7, 2015.