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*
Hughes Michael Forrest

(Last) (First) (Middle)
C/O WIZE PHARMA, INC.
LEVEL 5, 97 PACIFIC HIGHWAY

(Street)
NORTH SYDNEY C3 2060

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/09/2021
3. Issuer Name and Ticker or Trading Symbol
Mawson Infrastructure Group Inc. [ WIZP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 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)
Common Stock 16,072 D
Common Stock 3,579,335 I By spouse
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
8% Convertible Note (1) (2) Common Stock 227,139 $0.339 I By Roscommon Capital Pty Ltd as trustee for the Michael Hughes Family Trust
Explanation of Responses:
1. The earlier of (a) August 12, 2021; and (b) the admission of the Issuer's shares to quotation on the NASDAQ Stock Market.
2. The 8% Convertible Note is required to be repaid on earliest of: (a) a trustee, receiver or other custodian is appointed for the Issuer, or the Issuer makes a general assignment for the benefit of its creditors; (b) the Issuer files for bankruptcy (c) an involuntary petition is filed against the Issuer (unless such petition is dismissed or discharged within 60 days under any bankruptcy statute now or hereafter in effect or a custodian, receiver, trustee, assignee for the benefit of creditors (or other similar official) is appointed to take possession, custody or control of any property of the Issuer; or (d) the Issuer resolves to dissolve.
/s/ Michael Forrest Hughes 03/24/2021
** 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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