SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Chen Deyin

(Last) (First) (Middle)
SUITE A-2F, 555 SHIHUI ROAD
SONGJIANG DISTRICT

(Street)
SHANGHAI F4 200135

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/10/2021
3. Issuer Name and Ticker or Trading Symbol
Lakeshore Acquisition I Corp. [ LAAA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Ordinary shares, par value $0.0001 844,186(1) I Held by RedOne Investment Limited(2)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Represents the founder shares issued to RedOne Investment Limited in connection with the Company's initial public offering ("IPO") and includes 115,329 ordinary shares, par value $0.0001 (the "Ordinary Shares"), which are subject to forfeiture to the extent the underwriters of the IPO exercise their overallotment option.
2. Held by RedOne Investment Limited. Mr. Chen is the managing member of RedOne Investment Limited and has voting and investment discretion with respect to the Ordinary Shares held of record by RedOne Investment Limited. Mr. Chen disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
By: /s/ Chen Deyin 06/17/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.