0001094891-17-000182.txt : 20170815 0001094891-17-000182.hdr.sgml : 20170815 20170815164906 ACCESSION NUMBER: 0001094891-17-000182 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170815 FILED AS OF DATE: 20170815 DATE AS OF CHANGE: 20170815 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Donaldson Richard C CENTRAL INDEX KEY: 0001416656 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38186 FILM NUMBER: 171034366 MAIL ADDRESS: STREET 1: C/O CAPITOL ACQUISITION CORP. STREET 2: 509 7TH STREET, N.W. CITY: WASHINGTON STATE: DC ZIP: 20004 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Capitol Investment Corp. IV CENTRAL INDEX KEY: 0001709682 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 000000000 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 509 7TH STREET, N.W. CITY: WASHINGTON STATE: DC ZIP: 20004 BUSINESS PHONE: 202-654-7060 MAIL ADDRESS: STREET 1: 509 7TH STREET, N.W. CITY: WASHINGTON STATE: DC ZIP: 20004 3 1 edgar.xml PRIMARY DOCUMENT X0206 3 2017-08-15 0 0001709682 Capitol Investment Corp. IV CIC 0001416656 Donaldson Richard C C/O CAPITOL INVESTMENT CORP. IV 509 7TH STREET, N.W. WASHINGTON DC 20004 1 0 0 0 Class B ordinary shares Class A ordinary shares 50000 D Warrants 11.50 Class A ordinary shares 133333 D The Class B ordinary shares are convertible for the Issuer's Class A ordinary shares as described under the heading "Description of Securities - Founder Shares" in the Issuer's registration statement on Form S-1 (File No. 333-219146) and have no expiration date. These warrants will be purchased by Mr. Donaldson simultaneously with the consummation of the IPO. The warrants will become exercisable on the later of 30 days after the completion of the Issuer's initial business combination or 12 months from the closing of the IPO. The warrants will expire on the fifth anniversary of the completion of the Issuer's initial business combination. /s/ Richard C. Donaldson 2017-08-15