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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/30/2020 |
3. Issuer Name and Ticker or Trading Symbol
InsPro Technologies Corp [ ITCC ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. 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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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Common Stock, par value $0.001 | 30,646,874(1)(2)(3) | I | See notes 1,2 and 3 in "Explanation of Responses" below. |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Series A Preferred Stock, par value $0.001 | (1)(2)(3)(4) | (1)(2)(3)(5) | Common Stock | 7,000,000 | (6) | I | See notes 1,2 and 3 in "Explanation of Responses" below. |
Series B Preferred Stock, par value $0.001 | (1)(2)(3)(4) | (1)(2)(3)(5) | Common Stock | 86,543,720 | (6) | I | See notes 1,2 and 3 in "Explanation of Responses" below. |
Series C Preferred Stock, par value $0.001 | (1)(2)(3)(4) | (1)(2)(3)(5) | Common Stock | 20,000,000 | (6) | I | See notes 1,2 and 3 in "Explanation of Responses" below. |
Explanation of Responses: |
1. Securities beneficially owned as a result of Majesco and a wholly-owned subsidiary of Majesco ("Merger Sub") entering into Voting Agreements, dated as of January 30, 2020, with certain stockholders of the Issuer (the "Voting Agreements"). Concurrently with the execution of the Voting Agreements, Majesco, Merger Sub and the Issuer entered into an Agreement and Plan of Merger, pursuant to which Merger Sub will be merged with and into the Issuer (the "Merger Agreement") with the Issuer continuing as the surviving corporation. |
2. As a result of certain voting provisions contained in the Voting Agreements, the Reporting Person may be deemed to have beneficial ownership of the following shares of the Issuer's securities (the "Shares") covered by the Voting Agreements: 30,646,874 shares of common stock, 350,000 shares of Series A Preferred Stock, 4,327,186 shares of Series B Preferred Stock and 1,000,000 shares of Series C Preferred Stock. |
3. The Reporting Person expressly disclaims any beneficial ownership of the Shares reported herein, and the Reporting Person does not have any pecuniary interest (as defined in Rule 16a-1(a)(2) of the Securities Exchange Act of 1934, as amended) in any of the Shares subject to the Voting Agreements. The Reporting Person declares that the filing of this Form 3 shall not be construed as an admission that the Reporting Person is the beneficial owner of any Shares reported in this Form 3. For additional information regarding the Voting Agreements and the Merger Agreement, see the Schedule 13D filed by Majesco with the United Securities and Exchange Commission on January 31, 2020. |
4. The preferred stock is exercisable at any time. |
5. The preferred stock has no expiration date. |
6. Each share of preferred stock is convertible into 20 shares of the Issuer's common stock. |
/s/ Wayne Locke | 02/03/2020 | |
** 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. |