0001181431-11-055528.txt : 20111109 0001181431-11-055528.hdr.sgml : 20111109 20111109132655 ACCESSION NUMBER: 0001181431-11-055528 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111108 FILED AS OF DATE: 20111109 DATE AS OF CHANGE: 20111109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shulman Amichai CENTRAL INDEX KEY: 0001533440 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111190743 MAIL ADDRESS: STREET 1: IMPERVA, INC. STREET 2: 3400 BRIDGE PARKWAY, SUITE 200 CITY: REDWOOD SHORES STATE: CA ZIP: 94065 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: IMPERVA INC CENTRAL INDEX KEY: 0001364962 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 030460133 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3400 BRIDGE PARKWAY, SUITE 200 CITY: REDWOOD SHORES STATE: CA ZIP: 94065 BUSINESS PHONE: 650-345-9000 MAIL ADDRESS: STREET 1: 3400 BRIDGE PARKWAY, SUITE 200 CITY: REDWOOD SHORES STATE: CA ZIP: 94065 4 1 rrd324560.xml FORM 4 X0304 4 2011-11-08 0 0001364962 IMPERVA INC IMPV 0001533440 Shulman Amichai C/O IMPERVA, INC. 3400 BRIDGE PARKWAY, SUITE 200 REDWOOD SHORES CA 94065 0 1 0 0 Chief Technology Officer Common Stock 2011-11-08 4 S 0 125000 18.00 D 337500 I See footnote Common Stock 500000 I See footnote The shares are owned of record by Amichai Shulman Assets 2000 Ltd. The Reporting Person is a director and beneficial owner of the shares held by such entity. The shares are owned of record by Amichai Shulman Holdings 2000 Ltd. The Reporting Person is a director and beneficial owner of the shares held by such entity. /s/ Tram Phi, by power of attorney 2011-11-08