Statement of Changes in Beneficial Ownership (4)
2021年10月16日 - 5:02AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
COHEN DANIEL G |
2. Issuer Name and Ticker or Trading Symbol
Fintech Acquisition Corp V
[
FTCV
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Executive Officer |
(Last)
(First)
(Middle)
2929 ARCH STREET, SUITE 1703 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
4/4/2021 |
(Street)
PHILADELPHIA, PA 19104
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Class B Common Stock | (1) | 4/4/2021 | | J (2) | | | 33334 | (1) | (1) | Class A Common Stock | 33334 | $0.0029 | 1363222 (3) | I | By Cohen Sponsor Interests IV, LLC (4) |
Class B Common Stock | (1) | 4/4/2021 | | J (2) | | | 33334 | (1) | (1) | Class A Common Stock | 33334 | $0.0029 | 1363222 (3) | I | By DGC Family FinTech Trust (4)(5) |
Class B Common Stock | (1) | 10/13/2021 | | J (2) | | | 2917 | (1) | (1) | Class A Common Stock | 2917 | $0.0029 | 1360305 (3) | I | By Cohen Sponsor Interests V, LLC (4) |
Class B Common Stock | (1) | 10/13/2021 | | J (2) | | | 2917 | (1) | (1) | Class A Common Stock | 2917 | $0.0029 | 1360305 (3) | I | By DGC Family FinTech Trust (4)(5) |
Explanation of Responses: |
(1) | The shares of Class B common stock will automatically convert into shares of Class A common stock at the time of the issuer's initial business combination on a one-for-one basis, subject to certain adjustments described in the issuer's charter documents and have no expiration date. |
(2) | Represents transfer of membership interests to a new member of the issuer's sponsors at the original purchase price. |
(3) | The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for any other purpose. |
(4) | These shares are held directly by the issuer's sponsors, FinTech Investor Holdings V, LLC and FinTech Masala Advisors V, LLC, each of which is managed by Cohen Sponsor Interests V, LLC. The reporting person is an indirect owner of Cohen Sponsor Interests V, LLC. |
(5) | DGC Family FinTech Trust is an indirect owner of Cohen Sponsor Interests V, LLC. The children of the reporting person are the beneficiaries of DGC Family FinTech Trust. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
COHEN DANIEL G 2929 ARCH STREET, SUITE 1703 PHILADELPHIA, PA 19104 |
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| Chief Executive Officer |
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Signatures
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/s/ Amanda Abrams, as attorney-in-fact | | 10/15/2021 |
**Signature of Reporting Person | Date |
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