0001213900-20-041652.txt : 20201208 0001213900-20-041652.hdr.sgml : 20201208 20201208172414 ACCESSION NUMBER: 0001213900-20-041652 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201204 FILED AS OF DATE: 20201208 DATE AS OF CHANGE: 20201208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Smith, Jr. Thomas S. CENTRAL INDEX KEY: 0001601765 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39754 FILM NUMBER: 201376145 MAIL ADDRESS: STREET 1: 2 PENN PLAZA CITY: NEW YORK STATE: NY ZIP: 10121 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Capitol Investment Corp. V CENTRAL INDEX KEY: 0001722438 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 000000000 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ARLINGTON TOWER STREET 2: 1300 N 17TH STREET, SUITE 820 CITY: ARLINGTON STATE: VA ZIP: 22209 BUSINESS PHONE: (202) 654-7060 MAIL ADDRESS: STREET 1: ARLINGTON TOWER STREET 2: 1300 N 17TH STREET, SUITE 820 CITY: ARLINGTON STATE: VA ZIP: 22209 4 1 ownership.xml ONWERSHIP DOCUMENT X0306 4 2020-12-04 0 0001722438 Capitol Investment Corp. V CAP 0001601765 Smith, Jr. Thomas S. 1300 17TH STREET NORTH, SUITE 820 ARLINGTON VA 22209 1 0 0 0 Warrants 11.50 2020-12-04 4 P 0 133333 1.50 A Class A Common Stock 133333 133333 D The warrants will become exercisable commencing on the later of 12 months from the closing of the Issuer's initial public offering and 30 days after the completion of the Issuer's initial business combination, and will expire five years after the completion of the Issuer's initial business combination or earlier upon redemption or liquidation. /s/ L. Dyson Dryden, Attorney-in-Fact for Thomas S. Smith, Jr. 2020-12-08