SEC Form 5/A · accession 0001594062-18-000026
Rafina Innovations Inc. · VICA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 5/A). It replaces an earlier filing for the same period.
Reporting owner
Sergios Katsaros
Officer — Vice President
Period of report
Dec 31, 2017
Accepted (ET)
Feb 1, 2018 · 4:24 pm 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 stock | holding | — | — | — | 1,300,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock OptionF1 | $0.05 | Dec 12, 2017 | A | 10,000,000 | A | Dec 12, 2017 | Dec 12, 2022 | Common Stock | 10,000,000 | 10,000,000 | D |
Explanation of responses
- F1On December 12, 2017 the Reporting Person entered into an amended consulting agreement where under he is entitled to acquire at his discretion 10,000,000 shares of the Issuer's common stock at a price of $0.05 per share, for a term of five years from the agreement date.
Remarks
The Reporting Person filed a Form 5 on February 1, 2018 which inadvertently omitted the transaction as described in Table II above. This Form 5/A is being filed to include the reported transaction.