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