SEC FORM 4

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

LI CHUWAN HAU

(Last)

(First)

(Middle)

7F, NO. 88, CHANG'AN W. RD.

DATONG DIST.

(Street)

TAIPEI CITY

103

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
China United Insurance Service, Inc. [ CUII ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
02/13/2015

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	03/31/2015		M		352,166	A	⁽¹⁾	1,352,166	D

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Call Option (Right to Buy)	⁽¹⁾	02/13/2015		A		1		02/13/2015	08/13/2015	Common Stock	352,166	⁽¹⁾	0	D
Call Option (Right to Buy)	⁽¹⁾	03/31/2015		M			1	02/13/2015	08/13/2015	Common Stock	352,166	⁽¹⁾	0	D
Put Option (Right to Sell)	⁽²⁾	02/28/2016		A		1		02/28/2016	08/08/2016	Common Stock	352,166	$0⁽²⁾	0	D
Put Option (Right to Sell)	⁽²⁾	08/08/2016		J⁽²⁾			1	02/28/2016	08/08/2016	Common Stock	352,166	$0⁽²⁾	0	D

Explanation of Responses:

1. Pursuant to the terms of an acquisition agreement (the "Acquisition Agreement"), on February 13, 2015 the Reporting Person received from the Issuer the right to acquire 352,166 shares of Common Stock of the Issuer in exchange for 352,166 shares of Action Holdings Financial Limited (the "AHFL Shares") to be transferred by the Reporting Person to the Issuer (the "Call Option"). The Acquisition Agreement did not assign a dollar value to the shares of Common Stock, the AHFL Shares, the Call Option or the property transferred by the Reporting Person to the Issuer in the transaction. The Reporting Person exercised the Call Option on March 31, 2015 in exchange for the AHFL Shares.

2. The Issuer and the Reporting Person amended (the "Amendment") the Acquisition Agreement on February 17, 2016 to provide that if the Issuer did not achieve certain goals by February 28, 2016, the Reporting Person would have the right to put back to the Issuer 352,166 shares of Common Stock of the Issuer in exchange for 352,166 shares of Action Holdings Financial Limited then held by the Issuer (the "Put Option"). The Issuer did not achieve the goals and on February 28, 2016 the Put Option became exercisable by the Reporting Person. On August 8, 2016, the Amendment was subsequently terminated and as a result the Put Option was cancelled with no value received.

	/s/ Chuwan Hau Li	04/11/2017
	** Signature of Reporting Person	Date
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