0001209191-19-021476.txt : 20190327
0001209191-19-021476.hdr.sgml : 20190327
20190327182127
ACCESSION NUMBER: 0001209191-19-021476
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20190327
FILED AS OF DATE: 20190327
DATE AS OF CHANGE: 20190327
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KHAZI FAYAZ
CENTRAL INDEX KEY: 0001770314
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38841
FILM NUMBER: 19709367
MAIL ADDRESS:
STREET 1: C/O PRECISION BIOSCIENCES, INC.
STREET 2: 302 EAST PETTIGREW STREET, SUITE A-100
CITY: DURHAM
STATE: NC
ZIP: 277001
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: PRECISION BIOSCIENCES INC
CENTRAL INDEX KEY: 0001357874
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 302 EAST PETTIGREW STREET
STREET 2: SUITE A-100
CITY: DURHAM
STATE: NC
ZIP: 27701
BUSINESS PHONE: 919-314-5512
MAIL ADDRESS:
STREET 1: 302 EAST PETTIGREW STREET
STREET 2: SUITE A-100
CITY: DURHAM
STATE: NC
ZIP: 27701
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2019-03-27
0
0001357874
PRECISION BIOSCIENCES INC
DTIL
0001770314
KHAZI FAYAZ
C/O PRECISION BIOSCIENCES, INC.
302 E. PETTIGREW STREET, SUITE A-100
DURHAM
NC
27701
0
1
0
0
CEO of Elo Life Systems
Employee Stock Option (Right to Buy)
1.18
2027-04-30
Common Stock
163958
D
Employee Stock Option (Right to Buy)
11.98
2028-09-27
Common Stock
46845
D
The option vests as to 25% of the underlying shares on March 24, 2018 and vests in equal installments at the end of each successive three-month period over the following 36 months.
The option vests as to 25% of the underlying shares on September 28, 2019 and vests in equal installments at the end of each successive three-month period over the following 36 months.
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Abid Ansari, Attorney-in-Fact for Fayaz Khazi, Ph.D.
2019-03-27
EX-24.3_844521
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby makes, constitutes and
appoints Michael P. Saber, Heyward D. Armstrong, Amanda L. Keister, and Abid
Ansari, and each of them singly, as the undersigned's true and lawful
attorneys-in-fact with full power and authority as hereinafter described to:
1. execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer, director and/or stockholder of Precision BioSciences, Inc. (the
"Company"), (i) Forms 3, 4, and 5 (including amendments thereto) in accordance
with Section 16(a) of the Securities Exchange Act of 1934, as amended (the
"Exchange Act"), and the rules thereunder, (ii) Form 144 in accordance with Rule
144 under the Securities Act of 1933, as amended (the "Securities Act"), and
(iii) Schedules 13D and 13G (including amendments thereto) in accordance with
Sections 13(d) and 13(g) of the Exchange Act and the rules thereunder;
2. do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Form 3, 4, or 5
(including amendments thereto), Form 144, or Schedule 13D or 13G (including
amendments thereto) and timely file such form with the United States Securities
and Exchange Commission (the "SEC") and any stock exchange or similar authority,
including, but not limited to, executing a Form ID for and on behalf of the
undersigned and filing such Form ID with the SEC; and
3. take any other action of any type whatsoever in connection with the foregoing
which, in the opinion of such attorney-in-fact, may be of benefit to, in the
best interest of, or legally required by, the undersigned, it being understood
that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Limited Power of Attorney shall be in such form and
shall contain such terms and conditions as such attorney-in-fact may approve in
such attorney-in-fact's discretion.
The undersigned hereby grants to each attorney-in-fact full power and authority
to do and perform any and every act and thing whatsoever requisite, necessary,
or proper to be done in the exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as the undersigned might or could
do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all the acts such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Limited Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that each of the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, is not assuming any of the undersigned's responsibilities to comply
with Sections 13 or 16 of the Exchange Act or Rule 144 under the Securities Act.
The undersigned hereby revokes any and all prior powers of attorney executed for
this purpose. This Limited Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to file Forms 3, 4, and 5
(including amendments thereto), Form 144, and Schedules 13D and 13G (including
amendments thereto) with respect to the undersigned's holdings of and
transactions in securities issued by the Company, unless earlier revoked by the
undersigned in a signed writing delivered to each of the foregoing
attorneys-in-fact. In addition, at such time as any attorney-in-fact (i) ceases
to serve as an employee or counsel of the Company or any subsidiary of the
Company or (ii) resigns as attorney-in-fact by the execution of a written
resignation delivered to the undersigned or the Company, without any action on
the part of the undersigned, this Limited Power of Attorney shall be partially
revoked solely with respect to such individual; such individual shall cease to
be an attorney-in-fact under this Limited Power of Attorney; and the authority
of the other attorneys-in-fact then existing hereunder shall remain in full
force and effect.
IN WITNESS WHEREOF, the undersigned has caused this Limited Power of Attorney to
be executed as of this 15 day of October, 2018.
By: /s/ Fayaz Khazi
Print Name: Fayaz Khazi Ph.D.