15-12B 1 exam20160805_1512b.htm FORM 15-12B exam20160805_1512b.htm

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 


 

FORM 15

 


 

CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934

OR SUSPENSION OF DUTY TO FILE REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.

 

Commission File Number 001-34930

 


 

ExamWorks Group, Inc.

(Exact name of registrant as specified in its charter)

 


 

3280 Peachtree Road, N.E.

Suite 2625

Atlanta, GA 30305

(404) 952-2400

(Address, including zip code, and telephone number, including area code, of registrants principal executive offices)

 

Common Stock, $0.0001 par value per share

(Title of each class of securities covered by this Form)

 

None

(Titles of all other classes of securities for which a duty to file reports under section 13(a) or 15(d) remains)

 


 

Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:

 

 

 

Rule 12g-4(a)(1)

 

 

 

Rule 12g-4(a)(2)

 

    Rule 12h-3(b)(1)(i)  
    Rule 12h-3(b)(1)(ii)  
    Rule 15d-6  
    Rule 15d-22(b)        

 

Approximate number of holders of record as of the certification or notice date: One

 

 
 

 

 

 

 

Pursuant to the requirements of the Securities Exchange Act of 1934, ExamWorks Group, Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

 

 

 

 

 

ExamWorks Group, Inc.

 

 

 

 

 

       

Date: August 8, 2016   

By:

/s/ J. Miguel Fernandez de Castro

 

 

 

J. Miguel Fernandez de Castro

 

    Chief Financial Officer and Senior Executive  

 

 

Vice President