Statement of Changes in Beneficial Ownership (4)
2022年3月14日 - 11:12PM
Edgar (US Regulatory)
FORM 4
[X]
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
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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
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Martin Daniel G. |
2. Issuer Name and Ticker or Trading Symbol
NovAccess Global Inc.
[
XSNX
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
8834 MAYFIELD RD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/14/2022 |
(Street)
CHESTERLAND, OH 44026
(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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Series B Preferred Stock, $0.01 par value per share | 3/14/2022 | | J(1) | | 25000 | D | (1) | 0 | I | By TN3, LLC |
Common Stock, no par value | 3/14/2022 | | J(1) | | 1502670 | A | (1) | 1502670 | I | By TN3, LLC |
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 |
Series B Preferred Stock, $0.01 par value | $0 | 3/14/2022 | | J (1) | | | 25000 | 9/8/2020 | (2) | Common Stock, no par value | 250000000 | (1) | 0 | I | By TN3, LLC |
Explanation of Responses: |
(1) | Effective March 14, 2022, NovAccess Global Inc. redeemed 24,400, and Irvin Consulting, LLC purchased 600, shares of Series B preferred stock held by TN3, LLC, a company owned by Mr. Martin. In connection with the sale and redemption of the preferred shares, NovAccess issued to TN3 1,502,670 shares of unregistered common stock and will pay to TN3 $250,000 over time. |
(2) | Each share of Series B preferred stock is convertible at the option of the holder into 10,000 shares of common stock and entitles the holder to cast 40,000 votes on any action presented to shareholders. The preferred stock conversion feature has no expiration date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Martin Daniel G. 8834 MAYFIELD RD CHESTERLAND, OH 44026 |
| X |
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Signatures
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/s/ Daniel G. Martin | | 3/14/2022 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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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