0000950103-21-011669.txt : 20210730
0000950103-21-011669.hdr.sgml : 20210730
20210730213238
ACCESSION NUMBER: 0000950103-21-011669
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210728
FILED AS OF DATE: 20210730
DATE AS OF CHANGE: 20210730
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Rizvi Hasan
CENTRAL INDEX KEY: 0001868803
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39754
FILM NUMBER: 211134362
MAIL ADDRESS:
STREET 1: 101 MISSION ST.
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Doma Holdings, Inc.
CENTRAL INDEX KEY: 0001722438
STANDARD INDUSTRIAL CLASSIFICATION: TITLE INSURANCE [6361]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 101 MISSION STREET
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
BUSINESS PHONE: (650) 419-3827
MAIL ADDRESS:
STREET 1: 101 MISSION STREET
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
FORMER COMPANY:
FORMER CONFORMED NAME: Capitol Investment Corp. V
DATE OF NAME CHANGE: 20171113
4
1
dp155506_4-rizvi.xml
FORM 4
X0306
4
2021-07-28
0
0001722438
Doma Holdings, Inc.
DOMA
0001868803
Rizvi Hasan
101 MISSION ST. SUITE 740
SAN FRANCISCO
CA
94105
0
1
0
0
Chief Technology Officer
Common Stock
2021-07-28
4
A
0
599493
A
599493
D
Stock Options (Right to Buy)
0.45
2021-07-28
4
A
0
2386419
A
2029-04-15
Common stock
2386419
2386419
D
Stock Options (Right to Buy)
0.71
2021-07-28
4
A
0
149873
A
2030-06-02
Common stock
149873
149873
D
Stock Options (Right to Buy)
0.71
2021-07-28
4
A
0
59949
A
2031-01-27
Common stock
59949
59949
D
Received in exchange for shares of common stock of Doma Holdings, Inc., which was formerly known as States Title Holding, Inc. ("Former Doma") in connection with the merger by and among Capitol Investment Corp V., Capitol V Merger Sub, Inc. and Former Doma (the "Merger").
The option vests in 25% on the first anniversary of March 18, 2019 and in equal monthly installments thereafter until it is fully vested on the fourth anniversary of such date. The stock option was received in the Merger in exchange for a stock option to acquire shares of Former Doma common stock.
The option vests in 25% on the first anniversary of March 1, 2020 and in equal monthly installments thereafter until it is fully vested on the fourth anniversary of such date. The stock option was received in the Merger in exchange for a stock option to acquire shares of Former Doma common stock.
The option vests in 25% on the first anniversary of March 1, 2021 and in equal monthly installments thereafter until it is fully vested on the fourth anniversary of such date. The stock option was received in the Merger in exchange for a stock option to acquire shares of Former Doma common stock.
/s/ Christian Ameri, as Attorney-in-Fact for Hasan Rizvi
2021-07-30