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*
Power Den Beverley

(Last) (First) (Middle)
CANON'S COURT
22 VICTORIA STREET

(Street)
HAMILTON H12 D0 HM12

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/19/2021
3. Issuer Name and Ticker or Trading Symbol
Wejo Group Ltd [ WEJO ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief People 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)
Common Shares 127,851 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
Earnout Shares (1) (1) Common Shares 11,689 (1) D
Explanation of Responses:
1. Pursuant to the Agreement and Plan of Merger, dated as of May 28, 2021, among the Issuer and certain other parties (the "Agreement"), the Reporting Person has the contingent right to receive a pro rata amount of Common Shares in each of four earnout periods, if at any time during the seven year period following November 18, 2021, the volume weighted average price of a Common Share is greater than or equal to, for any 20 trading days within any 30 consecutive trading day period (an "earnout period"): $15.00 for the first earnout period; $18.00 for the second earnout period; $21.00 for the third earnout period; and $24.00 for fourth earnout period, as adjusted pursuant to the Agreement.
Remarks:
Exhibit 24 - Power of Attorney, incorporated herein by reference
/s/ Mina Bhama, as attorney in fact for Den Power 11/19/2021
** 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.