0001140361-21-007009.txt : 20210302
0001140361-21-007009.hdr.sgml : 20210302
20210302201953
ACCESSION NUMBER: 0001140361-21-007009
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210226
FILED AS OF DATE: 20210302
DATE AS OF CHANGE: 20210302
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Keller Rachelle
CENTRAL INDEX KEY: 0001758138
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38731
FILM NUMBER: 21706511
MAIL ADDRESS:
STREET 1: 14 WESLEY STREET
CITY: HAMILTON
STATE: D0
ZIP: HM11
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Sirius International Insurance Group, Ltd.
CENTRAL INDEX KEY: 0001744894
STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331]
IRS NUMBER: 980529995
STATE OF INCORPORATION: D0
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 14 WESLEY STREET, 5TH FLOOR
CITY: HAMILTON
STATE: D0
ZIP: HM11
BUSINESS PHONE: 1-441-278-3140
MAIL ADDRESS:
STREET 1: 14 WESLEY STREET, 5TH FLOOR
CITY: HAMILTON
STATE: D0
ZIP: HM11
4
1
form4.xml
FORM 4
X0306
4
2021-02-26
true
0001744894
Sirius International Insurance Group, Ltd.
SG
0001758138
Keller Rachelle
14 WESLEY STREET
HAMILTON
D0
HM11
BERMUDA
true
Common Shares
2021-02-26
4
D
0
2805
D
6923
D
Common Shares
2021-02-26
4
D
0
6923
D
0
D
Represents shares of common stock of the issuer ("Sirius Shares") disposed of in connection with the merger of the issuer with Third Point Reinsurance Ltd. ("TPRE") (the "Merger"), which closed on February 26, 2021 (the "Effective Time"), and exchanged for a combination of common shares, par value $0.10 per share, of TPRE (the "TPRE Shares") and contingent value right ("CVR") consideration comprising (1) 0.743 of a TPRE Share and (2) one contractual CVR, which represents the right to receive a contingent cash payment, which, taken together with the fraction of the TPRE Share received, guarantee that on the second anniversary of the Effective Time, the electing shareholder will have received equity and cash equal to at least $13.73 per Sirius Share.
Represents restricted shares that immediately vested following the closing of the Merger. These shares were disposed of in connection with the Merger and exchanged for a combination of TPRE Shares and CVR consideration comprising (1) 0.743 of a TPRE Share and (2) one contractual CVR, which represents the right to receive a contingent cash payment, which, taken together with the fraction of the TPRE Share received, guarantee that on the second anniversary of the Effective Time, the electing shareholder will have received equity and cash equal to at least $13.73 per Sirius Share.
/s/ Rachelle Keller
2021-03-02