SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Kastin David

(Last) (First) (Middle)
C/O CLEVER LEAVES HOLDINGS
489

(Street)
NEW YORK NY 10017

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/02/2021
3. Issuer Name and Ticker or Trading Symbol
Clever Leaves Holdings Inc. [ CLVR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
General Counsel
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Restricted Share Units(1) 20,000(2) D
Restricted Share Units(1) 25,000(3) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Restricted Share Units(1) (4) 12/18/2024 Common shares 20,000 $0.0 D
Explanation of Responses:
1. Each restricted share unit represents the contingent right to receive one common share of the Issuer.
2. The restricted share units will vest in four equal annual installments commencing on December 18, 2021, subject to the Reporting Person's continuous service with the Issuer through the relevant vesting dates.
3. The restricted share units will vest in four equal annual installments commencing on March 2, 2022, subject to the Reporting Person's continuous service with the Issuer through the relevant vesting dates.
4. The restricted share units vest when they have both time-vested and performance-vested, subject to the Reporting Person's continuous service with the Issuer through the relevant vesting dates. The restricted share units will time-vest in four equal annual installments, commencing on December 18, 2021, and will performance-vest based on the achievement of certain share price performance conditions on or prior to December 18, 2024.
Remarks:
/s/ David Kastin 06/04/2021
** 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 5 (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.