0001209191-17-029468.txt : 20170502
0001209191-17-029468.hdr.sgml : 20170502
20170502205816
ACCESSION NUMBER: 0001209191-17-029468
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20170428
FILED AS OF DATE: 20170502
DATE AS OF CHANGE: 20170502
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Axovant Sciences Ltd.
CENTRAL INDEX KEY: 0001636050
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
STATE OF INCORPORATION: D0
FISCAL YEAR END: 0331
BUSINESS ADDRESS:
STREET 1: CLARENDON HOUSE
STREET 2: 2 CHURCH STREET
CITY: HAMILTON
STATE: D0
ZIP: HM11
BUSINESS PHONE: 441-295-5950
MAIL ADDRESS:
STREET 1: CLARENDON HOUSE
STREET 2: 2 CHURCH STREET
CITY: HAMILTON
STATE: D0
ZIP: HM11
FORMER COMPANY:
FORMER CONFORMED NAME: Axovant Sciences, Inc.
DATE OF NAME CHANGE: 20150324
FORMER COMPANY:
FORMER CONFORMED NAME: Roivant Neurosciences Ltd.
DATE OF NAME CHANGE: 20150309
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Adasczik Michael
CENTRAL INDEX KEY: 0001649494
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37418
FILM NUMBER: 17806940
MAIL ADDRESS:
STREET 1: C/O AXOVANT SCIENCES, INC.
STREET 2: 320 WEST 37TH STREET, 5TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10018
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-04-28
0
0001636050
Axovant Sciences Ltd.
AXON
0001649494
Adasczik Michael
C/O AXOVANT SCIENCES, INC.
320 WEST 37TH STREET, 5TH FLOOR
NEW YORK
NY
10018
0
1
0
0
Principal Accounting Officer
Employee Stock Option (Right to Buy)
24.24
2017-04-28
4
A
0
12500
0.00
A
2027-04-28
Common Shares
12500
12500
D
This option vests over a period of four years, with one quarter of the common shares underlying the option vesting on April 28, 2018 and the remainder vesting in twelve equal quarterly installments thereafter.
The option allows for early exercise, subject to the Issuer's repurchase option with respect to any unvested common shares. All common shares underlying such option will become fully vested upon a change in
control, as that term is defined in the Issuer's 2015 Equity Incentive Plan.
Includes only options with the same termination date.
Exhibit List - Exhibit 24 - Power of Attorney
/s/ Brian Leaf, Attorney-in-Fact
2017-05-02
EX-24.4_720799
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
(For Executing Form ID and Forms 3, 4 and 5)
Know all by these presents, that the undersigned hereby constitutes and
appoints each of Brian F. Leaf and Alison Haggerty of Cooley LLP, Gregory
Weinhoff and Alexander Nguyen of Axovant Sciences, Inc., as the undersigned's
true and lawful attorneys-in fact and agents to:
(1) If necessary, prepare, execute in the undersigned's name and on the
undersigned's behalf, and submit to the Securities and Exchange Commission (the
"SEC") a Form ID, Uniform Application for Access Codes to File on EDGAR,
including amendments thereto, and any other documents necessary or appropriate
to obtain codes and passwords enabling the undersigned to make electronic
filings with the SEC of reports required by Section 16(a) of the Securities and
Exchange Act of 1934, as amended (the "Exchange Act"), or any rule or regulation
thereunder;
(2) Prepare, execute in the undersigned's name and on the undersigned's behalf,
and submit to the SEC Forms 3, 4 and 5 (including amendments thereto and joint
filing agreements in connection therewith) in accordance with Section 16(a) of
the Exchange Act and the rules thereunder in the undersigned's capacity as an
officer, director or beneficial owner of more than 10% of a registered class of
securities of Axovant Sciences Ltd. (the "Company");
(3) Do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to prepare and execute any such Forms 3, 4 or 5
(including amendments thereto and joint filing agreements in connection
therewith) and file such forms with the SEC and any stock exchange,
self-regulatory association or any similar authority; and
(4) Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required of the undersigned, it being
understood that the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as the attorney-in-fact may approve in the
attorney-in-fact's discretion.
The undersigned hereby grants to each such 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 that 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 power of attorney and the rights and powers herein granted. The
undersigned acknowledges that the foregoing attorneys-in-fact, and their
substitutes, in serving in such capacity at the request of the undersigned, are
not assuming (nor is the Company assuming) any of the undersigned's
responsibilities to comply with Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of (a) the undersigned is no longer required to file Forms 3, 4 and 5
with respect to the undersigned's holdings of and transactions in securities
issued by the Company, (b) revocation by the undersigned in a signed writing
delivered to the Company and the foregoing attorneys-in fact or (c) as to any
attorney-in-fact individually, until such attorney-in-fact is no longer employed
by the Company or Roivant Sciences, Inc., any of their wholly-owned
subsidiaries, or Cooley LLP, as applicable.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of the date written below.
Date: 4/28/17
Signature: /s/ Michael Adasczik
Print Name: Michael Adasczik