0000950170-24-047792.txt : 20240424 0000950170-24-047792.hdr.sgml : 20240424 20240424183005 ACCESSION NUMBER: 0000950170-24-047792 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240422 FILED AS OF DATE: 20240424 DATE AS OF CHANGE: 20240424 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHAH AJAY CENTRAL INDEX KEY: 0001008036 ORGANIZATION NAME: STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41094 FILM NUMBER: 24872229 MAIL ADDRESS: STREET 1: 2775 SAND HILL ROAD, SUITE 100 CITY: MENLO PARK STATE: CA ZIP: 94025 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Roadzen Inc. CENTRAL INDEX KEY: 0001868640 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] ORGANIZATION NAME: 02 Finance IRS NUMBER: 981600102 STATE OF INCORPORATION: D8 FISCAL YEAR END: 0331 BUSINESS ADDRESS: STREET 1: 111 ANZA BLVD., SUITE 109 CITY: BURLINGAME STATE: CA ZIP: 94010 BUSINESS PHONE: 650-414-3530 MAIL ADDRESS: STREET 1: 111 ANZA BLVD., SUITE 109 CITY: BURLINGAME STATE: CA ZIP: 94010 FORMER COMPANY: FORMER CONFORMED NAME: Vahanna Tech Edge Acquisition I Corp. DATE OF NAME CHANGE: 20210621 4 1 ownership.xml 4 X0508 4 2024-04-22 0001868640 Roadzen Inc. RDZN 0001008036 SHAH AJAY C/O ROADZEN INC. 111 ANZA BLVD., SUITE 109 BURLINGAME CA 94010 true false false false false Warrants (right to buy) 2024-04-22 4 J false 50000 A 2031-03-28 Ordinary shares 50000 50000 I The securities are held by KSFP. The exercise price of the warrants is equal to 80% of the lower of (i) the volume-weighted average price ("VWAP") of the ordinary shares of the Issuer over the 60 trading days subsequent to the first loan funding under the Notes (as defined below), (ii) the opening price of the Issuer's ordinary shares in any public offering of straight equity securities of the Issuer occurring within six months after the issue date of the warrants and (iii) the VWAP of the Issuer's ordinary shares over the 60 trading days immediately prior to the Vesting Date (as defined below). Krishnan-Shah Family Partners LP ("KSFP") received the warrants in connection with a loan made by KSFP to the Issuer on March 28, 2024, as evidenced by a senior secured promissory note issued by the Issuer (together with a senior secured promissory note issued by the Issuer to another person on that date, the "Notes"). The warrants are exercisable in full on March 28, 2025, or earlier under certain circumstances (as applicable, the "Vesting Date"). Ajay B. Shah & Lata K. Shah 1996 Trust LP is the general partner of KSFP (the "General Partner"). The reporting person and his wife, Mrs. Lata K. Shah, are the trustees of the General Partner and have voting and dispositive control over the securities held by KSFP. Accordingly, Mr. Shah and Mrs. Shah may be deemed to beneficially own the securities held by KSFP. /s/ Bruce Goldberg, Attorney-in-fact 2024-04-23