0000950170-24-047792.txt : 20240424
0000950170-24-047792.hdr.sgml : 20240424
20240424183005
ACCESSION NUMBER: 0000950170-24-047792
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240422
FILED AS OF DATE: 20240424
DATE AS OF CHANGE: 20240424
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SHAH AJAY
CENTRAL INDEX KEY: 0001008036
ORGANIZATION NAME:
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41094
FILM NUMBER: 24872229
MAIL ADDRESS:
STREET 1: 2775 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Roadzen Inc.
CENTRAL INDEX KEY: 0001868640
STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411]
ORGANIZATION NAME: 02 Finance
IRS NUMBER: 981600102
STATE OF INCORPORATION: D8
FISCAL YEAR END: 0331
BUSINESS ADDRESS:
STREET 1: 111 ANZA BLVD., SUITE 109
CITY: BURLINGAME
STATE: CA
ZIP: 94010
BUSINESS PHONE: 650-414-3530
MAIL ADDRESS:
STREET 1: 111 ANZA BLVD., SUITE 109
CITY: BURLINGAME
STATE: CA
ZIP: 94010
FORMER COMPANY:
FORMER CONFORMED NAME: Vahanna Tech Edge Acquisition I Corp.
DATE OF NAME CHANGE: 20210621
4
1
ownership.xml
4
X0508
4
2024-04-22
0001868640
Roadzen Inc.
RDZN
0001008036
SHAH AJAY
C/O ROADZEN INC.
111 ANZA BLVD., SUITE 109
BURLINGAME
CA
94010
true
false
false
false
false
Warrants (right to buy)
2024-04-22
4
J
false
50000
A
2031-03-28
Ordinary shares
50000
50000
I
The securities are held by KSFP.
The exercise price of the warrants is equal to 80% of the lower of (i) the volume-weighted average price ("VWAP") of the ordinary shares of the Issuer over the 60 trading days subsequent to the first loan funding under the Notes (as defined below), (ii) the opening price of the Issuer's ordinary shares in any public offering of straight equity securities of the Issuer occurring within six months after the issue date of the warrants and (iii) the VWAP of the Issuer's ordinary shares over the 60 trading days immediately prior to the Vesting Date (as defined below).
Krishnan-Shah Family Partners LP ("KSFP") received the warrants in connection with a loan made by KSFP to the Issuer on March 28, 2024, as evidenced by a senior secured promissory note issued by the Issuer (together with a senior secured promissory note issued by the Issuer to another person on that date, the "Notes").
The warrants are exercisable in full on March 28, 2025, or earlier under certain circumstances (as applicable, the "Vesting Date").
Ajay B. Shah & Lata K. Shah 1996 Trust LP is the general partner of KSFP (the "General Partner"). The reporting person and his wife, Mrs. Lata K. Shah, are the trustees of the General Partner and have voting and dispositive control over the securities held by KSFP. Accordingly, Mr. Shah and Mrs. Shah may be deemed to beneficially own the securities held by KSFP.
/s/ Bruce Goldberg, Attorney-in-fact
2024-04-23