0001209191-18-026335.txt : 20180426
0001209191-18-026335.hdr.sgml : 20180426
20180426204639
ACCESSION NUMBER: 0001209191-18-026335
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20180426
FILED AS OF DATE: 20180426
DATE AS OF CHANGE: 20180426
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Darling Scott C
CENTRAL INDEX KEY: 0001733959
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38465
FILM NUMBER: 18780621
MAIL ADDRESS:
STREET 1: C/O ZSCALER INC
STREET 2: 110 ROSE ORCHARD WAY
CITY: SAN JOSE
STATE: CA
ZIP: 95134
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: DOCUSIGN INC
CENTRAL INDEX KEY: 0001261333
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 912183967
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0131
BUSINESS ADDRESS:
STREET 1: 221 MAIN ST., SUITE 1000
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
BUSINESS PHONE: 866-219-4318
MAIL ADDRESS:
STREET 1: 221 MAIN ST., SUITE 1000
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2018-04-26
0
0001261333
DOCUSIGN INC
DOCU
0001733959
Darling Scott C
C/O DOCUSIGN, INC.
221 MAIN ST., SUITE 1000
SAN FRANCISCO
CA
94105
1
0
0
0
Common Stock
65759
I
See footnote
Series A Preferred Stock
Common Stock
1944674
I
See footnote
Series A-1 Preferred Stock
Common Stock
948167
I
See footnote
Series B Preferred Stock
Common Stock
4729005
I
See footnote
Series B-1 Preferred Stock
Common Stock
855646
I
See footnote
Series C Preferred Stock
Common Stock
942427
I
See footnote
Series D Preferred Stock
Common Stock
170295
I
See footnote
The shares are owned directly by Frazier Technology Ventures II, L.P. ("Frazier"). Frazier's sole general partner is FTVM II, L.P. ("FTVM II") and FTVM II's sole general partner is Frazier Technology Management, L.L.C. ("Frazier Tech Management"). Scott Darling is a managing member of Frazier Tech Management. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
The Series A Preferred Stock is convertible, at the option of the holder, into shares of Common Stock on a 1.02192925205-for-1 basis and will automatically convert into shares of Common Stock on a 1.02192925205-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series A Preferred Stock does not have an expiration date.
The Series A-1 Preferred Stock is convertible, at the option of the holder, into shares of Common Stock on a 1-for-1 basis and will automatically convert into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series A-1 Preferred Stock does not have an expiration date.
The Series B Preferred Stock is convertible, at the option of the holder, into shares of Common Stock on a 1-for-1 basis and will automatically convert into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series B Preferred Stock does not have an expiration date.
The Series B-1 Preferred Stock is convertible, at the option of the holder, into shares of Common Stock on a 1-for-1 basis and will automatically convert into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series B-1 Preferred Stock does not have an expiration date.
The Series C Preferred Stock is convertible, at the option of the holder, into shares of Common Stock on a 1-for-1 basis and will automatically convert into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series C Preferred Stock does not have an expiration date.
The Series D Preferred Stock is convertible, at the option of the holder, into shares of Common Stock on a 1-for-1 basis and will automatically convert into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series D Preferred Stock does not have an expiration date.
/s/ Yanira Wong, Attorney-in-fact
2018-04-26
EX-24.3_785216
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby makes, constitutes and
appoints Reginald D. Davis, Yanira Wong, Apple Palarca and Carlton Fleming as
the undersigned's true and lawful attorney-in-fact, with full power and
authority as hereinafter described on behalf of and in the name, place and stead
of the undersigned to:
(1) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5 (including
any amendments thereto) with respect to the securities of DocuSign, Inc., a
Delaware corporation (the "Company"), with the SEC, any national securities
exchanges and the Company, as considered necessary or advisable under Section
16(a) of the Exchange Act and the rules and regulations promulgated thereunder,
as amended from time to time;
(2) seek or obtain, as the undersigned's representative and on the undersigned's
behalf, information on transactions in the Company's securities from any third
party, including brokers, employee benefit plan administrators and trustees, and
the undersigned hereby authorizes any such person to release any such
information to the undersigned and approves and ratifies any such release of
information; and
(3) perform any and all other acts which in the discretion of such
attorney-in-fact are necessary or desirable for and on behalf of the undersigned
in connection with the foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not require, such
attorney-in-fact to act in their discretion on information provided to such
attorney-in-fact without independent verification of such information;
(2) any documents prepared and/or executed by such attorney-in-fact on behalf of
the undersigned pursuant to this Power of Attorney will be in such form and will
contain such information and disclosure as such attorney-in-fact, in his or her
discretion, deems necessary or desirable;
(3) neither the Company nor such attorney-in-fact assumes (i) any liability for
the undersigned's responsibility to comply with the requirement of the Exchange
Act, (ii) any liability of the undersigned for any failure to comply with such
requirements, or (iii) any obligation or liability of the undersigned for profit
disgorgement under Section 16(b) of the Exchange Act; and
(4) this Power of Attorney does not relieve the undersigned from responsibility
for compliance with the undersigned's obligations under the Exchange Act,
including without limitation the reporting requirements under Section 16 of the
Exchange Act.
The undersigned hereby gives and grants the foregoing attorney-in-fact full
power and authority to do and perform all and every act and thing whatsoever
requisite, necessary or appropriate to be done in and about the foregoing
matters as fully to all intents and purposes as the undersigned might or could
do if present, hereby ratifying all that such attorney-in-fact of, for and on
behalf of the undersigned, shall lawfully do or cause to be done by virtue of
this Limited Power of Attorney.
This Power of Attorney shall remain in full force and effect until revoked by
the undersigned in a signed writing delivered to such attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 21st day of March 2018.
/s/ Scott Darling