SEC Form 4 · accession 0001493152-19-000090

PetVivo Holdings, Inc. · PETV

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

Reporting owner

Director

Period of report

Jan 3, 2018

Accepted (ET)

Jan 3, 2019 · 12:09 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001512922

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1	Dec 31, 2018	J	66,667	$0.30	A	565,282	I	By Noble Ventures LLC
Common Stock^F2	Dec 31, 2018	X	10,000	$0.30	A	575,282	I	By Noble Ventures LLC
Common Stock^F3	Dec 31, 2018	J	3,333	$0.30	A	578,615	I	By Noble Ventures LLC
Common Stock^F4	Dec 31, 2018	X	10,000	$0.30	A	588,615	I	By Noble Ventures LLC
Common Stock^F5	Dec 31, 2018	J	3,333	$0.30	A	591,948	I	By Noble Ventures LLC

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Common Stock Warrant^F2	$0.30	Dec 31, 2018	A	10,000	A	Dec 31, 2018	Dec 31, 2021	Common Stock	10,000	97,500	I
Common Stock Warrant^F2	$0.30	Dec 31, 2018	X	10,000	D	Dec 31, 2018	Dec 31, 2021	Common Stock	10,000	87,500	I
Common Stock Warrant^F4	$0.30	Dec 31, 2018	A	10,000	A	Dec 31, 2018	Dec 31, 2018	Common Stock	10,000	97,500	I
Common Stock Warrant^F4	$0.30	Dec 31, 2018	X	10,000	D	Dec 31, 2018	Dec 31, 2018	Common Stock	10,000	87,500	I

F1Mr. Rudelius entered into a Bridge Promissory Note Agreement and subsequently a Bridge Promissory Note Conversion Agreement whereby he converted his $20,000 in outstanding principal and interest into 66,667 shares of Common Stock at a rate of $.30 per share.
F2Pursuant to entering into a Bridge Promissory Note Agreement, Mr. Rudelius received 10,000 warrants exercisable at $.30 per warrant if exercised on or before December 31, 2018.
F3Pursuant to exercising the warrants mentioned in explanation 2 above, Mr. Rudelius and John Lai entered into a Stock Transfer Agreement whereby John Lai Transferred 3,333 shares of Common Stock to Mr. Rudelius.
F4Pursuant to entering into a Bridge Promissory Note Conversion Agreement, Mr. Rudelius received 10,000 warrants exercisable at $.30 per warrant if exercised on or before December 31, 2018.
F5Pursuant to exercising the warrants mentioned in explanation 4 above, Mr. Rudelius and John Lai entered into a Stock Transfer Agreement whereby John Lai Transferred 3,333 shares of Common Stock to Mr. Rudelius.