0001213900-20-041650.txt : 20201208
0001213900-20-041650.hdr.sgml : 20201208
20201208172302
ACCESSION NUMBER: 0001213900-20-041650
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201204
FILED AS OF DATE: 20201208
DATE AS OF CHANGE: 20201208
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FERNANDEZ RAUL J
CENTRAL INDEX KEY: 0001106627
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39754
FILM NUMBER: 201376136
MAIL ADDRESS:
STREET 1: 11600 SUNRISE VALLEY DR
CITY: RESTON
STATE: VA
ZIP: 20191
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Capitol Investment Corp. V
CENTRAL INDEX KEY: 0001722438
STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770]
IRS NUMBER: 000000000
STATE OF INCORPORATION: E9
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: ARLINGTON TOWER
STREET 2: 1300 N 17TH STREET, SUITE 820
CITY: ARLINGTON
STATE: VA
ZIP: 22209
BUSINESS PHONE: (202) 654-7060
MAIL ADDRESS:
STREET 1: ARLINGTON TOWER
STREET 2: 1300 N 17TH STREET, SUITE 820
CITY: ARLINGTON
STATE: VA
ZIP: 22209
4
1
ownership.xml
OWNERSHIP DOCUMENT
X0306
4
2020-12-04
0
0001722438
Capitol Investment Corp. V
CAP
0001106627
FERNANDEZ RAUL J
1300 17TH STREET NORTH, SUITE 820
ARLINGTON
VA
22209
1
0
0
0
Warrants
11.50
2020-12-04
4
P
0
133333
1.50
A
Class A Common Stock
133333
133333
D
The warrants will become exercisable commencing on the later of 12 months from the closing of the Issuer's initial public offering and 30 days after the completion of the Issuer's initial business combination, and will expire five years after the completion of the Issuer's initial business combination or earlier upon redemption or liquidation.
/s/ L. Dyson Dryden, Attorney-in-Fact for Raul J. Fernandez
2020-12-08