Statement of Changes in Beneficial Ownership (4)
2018年10月3日 - 1:49AM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
ARRATA SAID
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2. Issuer Name
and
Ticker or Trading Symbol
DEEP WELL OIL & GAS INC
[
DWOG
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
#408, 600 PRINCETON WAY
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3. Date of Earliest Transaction
(MM/DD/YYYY)
6/10/2018
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(Street)
CALGARY, A0 T2P 5N4
(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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Common Shares
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6/10/2018
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M
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300000
(2)
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A
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$0.05
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1400000
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D
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Common Shares
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6/10/2018
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F
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214286
(2)
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D
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$0.07
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1185714
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D
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (right to acquire)
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$0.05
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6/10/2018
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M
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300000
(2)
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(1)
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6/20/2018
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Common Stock
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300000
(2)
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$0
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0
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D
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Stock Option (right to acquire)
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$0.38
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9/19/2014
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J
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0
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(3)
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9/19/2019
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Common Stock
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600000
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$0.38
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600000
(3)
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D
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Explanation of Responses:
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(1)
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On June 20, 2013, Deep Well Oil & Gas, Inc. (the "Issuer") granted non-qualified stock options to the reporting person to purchase up to 450,000 shares of common stock at an exercise price of $0.05 per common share, 150,000 vesting immediately and the remaining vesting one-third on June 20, 2014, and one-third on June 20, 2015, with an expiration date of June 20, 2018. In August of 2013, the reporting person exercised a portion of the June 20, 2016 non-qualified stock options for 150,000 shares of the Issuer's common stock, which such transaction was previously reported on Form 4.
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(2)
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The transactions reported, in the above Table I rows 1 and 2 and Table II row 1, reflect the cashless exercise of the reporting persons stock options. As of June 10, 2018, the reporting person exercised 300,000 of the remaining non-qualified stock options issued on June 20, 2013 of which 214,286 common shares were withheld by the Issuer at the market price of $0.07 per common share to fund the cashless exercise. 85,714 common shares of the Issuer's common stock were issued to the reporting person as a result of this cashless exercise. Where the number of common shares deducted for the cashless exercise is a fraction, the number has been rounded to the nearest whole number of common shares. The cashless exercise was approved by the Board of the Issuer and a majority of shareholders under the Issuer's stock option plan as amended.
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(3)
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On September 19, 2014, the Issuer's Board granted the reporting person, options to purchase 600,000 shares each of common stock at an exercise price of $0.38 per common share, with one-third vesting immediately, one-third vesting on September 19, 2015, and one-third vesting on September 19, 2016, each with a five-year life from the original grant date. The reporting person has not exercised any of these directly owned outstanding options. These options were previously disclosed on Form 4 and are again being disclosed in Table II row 2 of this Form 4.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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ARRATA SAID
#408, 600 PRINCETON WAY
CALGARY, A0 T2P 5N4
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X
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Signatures
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/s/ Said Arrata
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9/17/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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