X0204 3 2011-11-15 0 0001466301 Clovis Oncology, Inc. CLVS 0001354718 Halak Brian K C/O DOMAIN ASSOCIATES, LLC ONE PALMER SQUARE PRINCETON NJ 08542 0 0 1 0 Common Stock 32758 I By Domain Associates, L.L.C. Series A-1 Preferred Stock Common Stock 409192 I By Domain Partners VII, L.P. Series A-2 Preferred Stock Common Stock 409192 I By Domain Partners VII, L.P. Series B Preferred Stock Common Stock 885696 I By Domain Partners VII, L.P. Convertible Promissory Note Common Stock I By Domain Partners VII, L.P. Series A-1 Preferred Stock Common Stock 6979 I By DP VII Associates, L.P. Sereis A-2 Preferred Stock Common Stock 6979 I By DP VII Associates, L.P. Series B Preferred Stock Common Stock 15106 I By DP VII Associates, L.P. Convertible Promissory Note Common Stock I By DP VII Associates, L.P. All outstanding shares of the Issuer's preferred stock will automatically convert into Common Stock upon the closing of the Issuer's initial public offering (the "IPO"), for no additional consideration. The outstanding principal amount of the convertible promissory note and all accrued and unpaid interest thereon from and after May 25, 2011 will automatically convert into shares of Common Stock immediately prior to the closing of the IPO at a conversion price equal to the per share price to the public of the Common Stock sold in the IPO. The Reporting Person is a Managing Member of One Palmer Square Associates VII, LLC, which is the sole general partner of Domain Partners VII, L.P. and DP VII Associates, L.P., and Domain Associates, LLC. Pursuant to Instruction (5)(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by each such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his or her pecuniary interest therein and/or that are not actually distributed to him or her. /s/ Kathleen K. Schoemaker, Attorney-in-Fact 2011-11-15