0001493152-19-000090.txt : 20190103 0001493152-19-000090.hdr.sgml : 20190103 20190103120924 ACCESSION NUMBER: 0001493152-19-000090 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180103 FILED AS OF DATE: 20190103 DATE AS OF CHANGE: 20190103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rudelius Robert James CENTRAL INDEX KEY: 0001403679 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55167 FILM NUMBER: 19504168 MAIL ADDRESS: STREET 1: 6913 ARBOR LANE CITY: MCCLEAN STATE: VA ZIP: 22101 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PetVivo Holdings, Inc. CENTRAL INDEX KEY: 0001512922 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 990363559 STATE OF INCORPORATION: NV FISCAL YEAR END: 0331 BUSINESS ADDRESS: STREET 1: 5251 EDINA INDUSTRIAL BLVD CITY: EDINA STATE: MN ZIP: 55439 BUSINESS PHONE: (952) 217-4952 MAIL ADDRESS: STREET 1: 5251 EDINA INDUSTRIAL BLVD CITY: EDINA STATE: MN ZIP: 55439 FORMER COMPANY: FORMER CONFORMED NAME: Technologies Scan Corp DATE OF NAME CHANGE: 20110211 4 1 ownership.xml X0306 4 2018-01-03 0 0001512922 PetVivo Holdings, Inc. PETV 0001403679 Rudelius Robert James 5251 EDINA INDUSTRIAL BLVD EDINA MN 55439 1 0 0 0 Common Stock 2018-12-31 4 J 0 66667 .30 A 565282 I By Noble Ventures LLC Common Stock 2018-12-31 4 X 0 10000 .30 A 575282 I By Noble Ventures LLC Common Stock 2018-12-31 4 J 0 3333 .30 A 578615 I By Noble Ventures LLC Common Stock 2018-12-31 4 X 0 10000 .30 A 588615 I By Noble Ventures LLC Common Stock 2018-12-31 4 J 0 3333 .30 A 591948 I By Noble Ventures LLC Common Stock Warrant .30 2018-12-31 4 A 0 10000 20000 A 2018-12-31 2021-12-31 Common Stock 10000 97500 I By Noble Ventures LLC Common Stock Warrant .30 2018-12-31 4 X 0 10000 20000 D 2018-12-31 2021-12-31 Common Stock 10000 87500 I By Noble Ventures LLC Common Stock Warrant .30 2018-12-31 4 A 0 10000 20000 A 2018-12-31 2018-12-31 Common Stock 10000 97500 I By Noble Ventures LLC Common Stock Warrant .30 2018-12-31 4 X 0 10000 20000 D 2018-12-31 2018-12-31 Common Stock 10000 87500 I By Noble Ventures LLC Mr. Rudelius entered into a Bridge Promissory Note Agreement and subsequently a Bridge Promissory Note Conversion Agreement whereby he converted his $20,000 in outstanding principal and interest into 66,667 shares of Common Stock at a rate of $.30 per share. Pursuant to entering into a Bridge Promissory Note Agreement, Mr. Rudelius received 10,000 warrants exercisable at $.30 per warrant if exercised on or before December 31, 2018. Pursuant to exercising the warrants mentioned in explanation 2 above, Mr. Rudelius and John Lai entered into a Stock Transfer Agreement whereby John Lai Transferred 3,333 shares of Common Stock to Mr. Rudelius. Pursuant to entering into a Bridge Promissory Note Conversion Agreement, Mr. Rudelius received 10,000 warrants exercisable at $.30 per warrant if exercised on or before December 31, 2018. Pursuant to exercising the warrants mentioned in explanation 4 above, Mr. Rudelius and John Lai entered into a Stock Transfer Agreement whereby John Lai Transferred 3,333 shares of Common Stock to Mr. Rudelius. /s/ Robert Rudelius 2019-01-03