SEC Form 5 · accession 0001140361-16-052590

OXBRIDGE RE HOLDINGS Ltd · OXBR

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

A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).

Reporting owner

Officer — CEO, President · Director

Period of report

Dec 11, 2015

Accepted (ET)

Feb 16, 2016 · 9:18 am EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001584831

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Ordinary Shares^F1,F2	Dec 11, 2015	J	15,235	$0.00	D	0	I	See Footnote
Ordinary Shares^F1,F3	Dec 11, 2015	J	15,231	$0.00	A	15,231	I	See Footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Warrants^F1,F2,F4	$7.50	Dec 11, 2015	J	28,778	D	—	Mar 31, 2019	Ordinary Shares	28,778	0	I
Warrants^F1,F2,F4	$7.50	Dec 11, 2015	J	28,768	A	—	Mar 31, 2019	Ordinary Shares	28,768	28,768	I

F1This transaction represents a change in the form of beneficial ownership as a result of a pro rata distribution of the ordinary shares and warrants held by Moksha Capital Partners Re (M) Ltd. to its beneficial owners.
F2Shares were held in the name of Moksha Capital Partners Re (M) Ltd.
F3Shares indirectly held in the name of Universal Finance and Investments, L.C. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of the reporting person's pecuniary interest in such securities.
F4Immediately exercisable.