SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
Chan Koon Keung

(Last) (First) (Middle)
I/C/O FORTUNE RISE ACQUISITION CORP
48 BRIDGE STREET, BUILDING A

(Street)
METUCHEN NJ 08840

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/02/2021
3. Issuer Name and Ticker or Trading Symbol
Fortune Rise Acquisition Corp [ FRLA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class B Common Stock(1) 2,000,000(2) I See footnote(3)
Class A Common Stock 505,500(2)(3) I See footnote(3)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Class B common stock will automatically convert into Class A common stock on one-for-one basis, subject to certain adjustments as provided in the 2nd amended and restated certificate of incorporation of Fortune Rise Acquisition Corporation upon the consummation of an initial business combination.
2. In connection with the closing of the initial public offering of the Issuer and the exercise of over-allotment option in full by underwriters on November 5, 2021, Koon Keung Chan is deemed to beneficially own 2,000,000 shares of Class B Common Stock and 505,500 shares of Class A Common Stock held by Fortune Rise Sponsor LLC.
3. Fortune Rise Sponsor LLC is the record holder of the shares reported herein. Koon Keung Chan is the manager of Fortune Rise Sponsor LLC. As such. Mr. Chan is deemed to have beneficial ownership of the shares of common stock held directly by Fortune Rise Sponsor LLC. Mr. Chan disclaims beneficial ownership over any securities owned by our sponsor in which he does not have any pecuniary interest.
/s/ Koon Keung Chan 11/08/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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