0000899243-21-010331.txt : 20210308
0000899243-21-010331.hdr.sgml : 20210308
20210308160522
ACCESSION NUMBER: 0000899243-21-010331
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210308
FILED AS OF DATE: 20210308
DATE AS OF CHANGE: 20210308
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kaul Samir
CENTRAL INDEX KEY: 0001501915
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40131
FILM NUMBER: 21721945
MAIL ADDRESS:
STREET 1: C/O KHOSLA VENTURES
STREET 2: 3000 SAND HILL ROAD, BLDG. 3, SUITE 170
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures SPAC Sponsor LLC
CENTRAL INDEX KEY: 0001846071
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40131
FILM NUMBER: 21721944
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 6503768500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SK SPAC Services, LLC
CENTRAL INDEX KEY: 0001848897
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40131
FILM NUMBER: 21721942
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 6503768500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures SPAC Sponsor Services LLC
CENTRAL INDEX KEY: 0001848793
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40131
FILM NUMBER: 21721943
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 6503768500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Khosla Ventures Acquisition Co.
CENTRAL INDEX KEY: 0001841873
STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-376-8500
MAIL ADDRESS:
STREET 1: 2128 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-03-08
0
0001841873
Khosla Ventures Acquisition Co.
KVSA
0001501915
Kaul Samir
C/O KHOSLA VENTURES ACQUISITION CO.
2128 SAND HILL RD
MENLO PARK
CA
94025
1
1
1
0
Chief Executive Officer
0001846071
Khosla Ventures SPAC Sponsor LLC
C/O KHOSLA VENTURES ACQUISITION CO.
2128 SAND HILL RD
MENLO PARK
CA
94025
0
0
1
0
0001848793
Khosla Ventures SPAC Sponsor Services LLC
C/O KHOSLA VENTURES ACQUISITION CO.
2128 SAND HILL RD
MENLO PARK
CA
94025
0
0
1
0
0001848897
SK SPAC Services, LLC
C/O KHOSLA VENTURES ACQUISITION CO.
2128 SAND HILL RD
MENLO PARK
CA
94025
0
0
1
0
Class A Common Stock
2021-03-08
4
A
0
990000
10.00
A
990000
I
See footnote
Khosla Ventures SPAC Sponsor LLC ("Sponsor") is the record holder of the shares reported herein. Khosla Ventures SPAC Sponsor Services LLC is the owner of Sponsor. VK Services LLC and SK SPAC Services, LLC are the joint owners of Khosla Ventures SPAC Sponsor Services LLC. Vinod Khosla and Samir Kaul are the managing members of VK Services LLC and SK SPAC Services, LLC, respectively. As such, each of VK Services LLC, SK SPAC Services, LLC and Messrs. Khosla and Kaul may be deemed to share beneficial ownership of the shares held directly by Sponsor. Each of VK Services LLC, SK SPAC Services, LLC and Messrs. Khosla and Kaul disclaim any beneficial ownership of such shares other than to the extent of their pecuniary interest therein.
/s/ Samir Kaul, on behalf of himself and each of Khosla Ventures SPAC Sponsor LLC, Khosla Ventures SPAC Sponsor Services LLC and SK SPAC Services, LLC
2021-03-08