SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
402 WEST 13TH STREET, 4TH FLOOR |
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(Street)
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2. Issuer Name and Ticker or Trading Symbol
Remitly Global, Inc.
[ RELY ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 09/27/2021
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction 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 |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
09/27/2021 |
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C |
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35,895 |
A |
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150,752 |
I |
See Footnote
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Common Stock |
09/27/2021 |
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C |
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749,298 |
A |
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900,050 |
I |
See Footnote
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Common Stock |
09/27/2021 |
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C |
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14,786,424 |
A |
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15,686,474 |
I |
See Footnote
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Common Stock |
09/27/2021 |
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C |
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2,110,038 |
A |
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17,796,512 |
I |
See Footnote
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Common Stock |
09/27/2021 |
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C |
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335,762 |
A |
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18,132,274 |
I |
See Footnote
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Common Stock |
09/27/2021 |
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C |
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475,179 |
A |
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18,607,453 |
I |
See Footnote
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction 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
(Month/Day/Year) |
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: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series Seed Convertible Preferred Stock |
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09/27/2021 |
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C |
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38,895 |
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Common Stock |
35,895 |
$0
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0 |
I |
See Footnote
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Series A Convertible Preferred Stock |
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09/27/2021 |
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C |
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749,298 |
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Common Stock |
749,298 |
$0
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0 |
I |
See Footnote
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Series C Convertible Preferred Stock |
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09/27/2021 |
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C |
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14,786,424 |
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Common Stock |
14,786,424 |
$0
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0 |
I |
See Footnote
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Series D Convertible Preferred Stock |
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09/27/2021 |
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C |
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2,110,038 |
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Common Stock |
2,110,038 |
$0
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0 |
I |
See Footnote
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Series E Convertible Preferred Stock |
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09/27/2021 |
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C |
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335,762 |
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Common Stock |
335,762 |
$0
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0 |
I |
See Footnote
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Series F Convertible Preferred Stock |
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09/27/2021 |
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C |
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475,179 |
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Common Stock |
475,179 |
$0
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0 |
I |
See Footnote
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1. Name and Address of Reporting Person*
402 WEST 13TH STREET, 4TH FLOOR |
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(Street)
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1. Name and Address of Reporting Person*
402 WEST 13TH STREET, 4TH FLOOR |
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(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
402 WEST 13TH STREET, 4TH FLOOR |
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(Street)
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Explanation of Responses: |
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see signatures attached as Exhibit 99.2 |
09/29/2021 |
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** 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 Number. |
Exhibit 99.1
Stripes III, LP ("Stripes LP") holds securities of the Issuer. Stripes GP III, LLC ("Stripes GP") serves as the general partner of Stripes LP. Stripes
Holdings, LLC ("Stripes Holdings") is the managing member of Stripes GP. Kenneth A. Fox is the managing member of Stripes Holdings.
Each of the entities listed above, other than Stripes LP, and Mr. Fox, disclaims beneficial ownership of any shares of the Issuer's common stock owned
of record by Stripes LP, except to the extent of any pecuniary interest therein, and the filing of this Form 4 shall not be construed as an admission that any such person or entity is the beneficial owner of any such securities for purposes of Section
16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.
Exhibit 99.2
This Statement on Form 4 is filed by: (i) Stripes III, LP; (ii)
Stripes GP III, LLC; (iii) Stripes Holdings, LLC; and (iv) Kenneth A. Fox.
Name of Designated Filer: Stripes Holdings, LLC
Date of Event Requiring Statement: September 27, 2021
Issuer Name and Ticker or Trading Symbol: Remitly Global, Inc. [RELY]
STRIPES III, LP
By: Stripes GP III, LLC,
its general partner
By:
Stripes Holdings, LLC,
its managing member
By: /s/ Wayne Marino, as attorney-in-fact
Kenneth A. Fox
Managing Member
STRIPES GP III, LLC
By:
Stripes Holdings, LLC,
its managing member
By: /s/ Wayne Marino, as attorney-in-fact
Kenneth A. Fox
Managing Member
STRIPES HOLDINGS, LLC
By:
/s/ Wayne Marino, as attorney-in-fact
Kenneth A. Fox
Managing Member
KENNETH A. FOX
/s/ Wayne Marino, as attorney-in-fact