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*
DABAH MOSHE

(Last) (First) (Middle)
C/O KIDPIK CORP.
200 PARK AVENUE SOUTH, 3RD FLOOR

(Street)
NEW YORK NY 10003

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/10/2021
3. Issuer Name and Ticker or Trading Symbol
KIDPIK CORP. [ PIK ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP, COO and CTO
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)
Common Stock 67,100(1)(2)(3) D
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
Restricted Stock Unit (4) (4) Common Stock 127,000 (5) D
Explanation of Responses:
1. These securities are also disclosed separately in the Form 3 (and will be disclosed in separate Form 4s) filed by Mr. Ezra Dabah, the Chief Executive Officer of the Issuer, and the father of Moshe Dabah, as a result of the voting agreement discussed in footnote (2) below.
2. Excludes securities owned by members of a Voting Group relating to a voting agreement dated September 1, 2021, between the reporting person and members of the Voting Group, for which the reporting person disclaim beneficial ownership (except as expressly set forth above). The Voting Group refers to members of a voting agreement with (and with respect to the reported securities owned by) Moshe Dabah, Eva Dabah, Joia Kazam, Chana Rapaport, Yaacov Dabah and trusts for the benefit of each of the foregoing, the co-trustees of which are the spouse and mother-in-law of Ezra Dabah; Trust FBO Josh A. Kazam, whose trustee is Greg Kiernan; Gila Goodman; Isaac Dabah and his spouse; GMM Capital LLC; and Sterling Macro Fund for purposes of Section 13(d) of the Securities Exchange Act of 1934.
3. Each member of the Voting Group provided complete authority to Mr. Ezra Dabah, the Chief Executive Officer of the Issuer (and the father of Moshe Dabah), to vote the shares held by such persons and entities at any and all meetings of stockholders of the Company and via any written consents.
4. The restricted stock units vest at the rate of (i) 1/3 on May 15, 2022 (six months from the closing of the Issuer's initial public offering ("IPO")); (ii) 1/3 on May 15, 2023 (eighteen months from the closing of the IPO); and (iii) 1/3 on May 15, 2024 (thirty months from the closing date of the IPO), subject to the reporting person's continued service through the applicable vesting date. Restricted stock units do not expire; they either vest or are canceled prior to vesting date.
5. Each restricted stock unit represents the contingent right to receive, at settlement, one share of common stock.
/s/ Moshe Dabah 12/03/2021
** 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.
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