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*
David Moshe

(Last) (First) (Middle)
59 HERUT STREET

(Street)
BINYAMINA L3 30500

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/27/2019
3. Issuer Name and Ticker or Trading Symbol
KIDOZ INC. [ KDOZF ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
Common Stock 543,379(1) D
Common Stock 339,612 I 100% Owned Company(2)
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
Employee Stock (Right to Buy) 06/30/2020 06/30/2020 Common Stock 300,000 $0.33(3) D
Explanation of Responses:
1. Mr Moshe David held and continues to hold 543,379 shares of Kidoz Inc. when he became a director of Kidoz Inc. at the Annual General Meeting on November 27, 2019.
2. Compass H.N.T Yazamut Ltd. holds 339,612 shares of Kidoz Inc. Compass H.N.T Yazamut Ltd. is 100% owned by Mr. Moshe David
3. Mr. Moshe David was granted 300,000 stock options of Kidoz Inc. at CAD$0.45 (approximately US$0.33) on June 30, 2020. These options vest 2.08% per month commencing June 30, 2021.
/s/ M. David 07/22/2020
** 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.
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