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*
Ambrose Catherine H

(Last) (First) (Middle)
78 SW 7TH STREET
INDIVIDUAL OFFICE NO. 07-156

(Street)
MIAMI FL 33130

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/28/2021
3. Issuer Name and Ticker or Trading Symbol
MELI Kaszek Pioneer Corp [ MEKA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
No securities are beneficially owned 0 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
Class L Ordinary Shares (1) (1) Class A Ordinary Shares 25,000(2)(3) (1) I(4) See Footnote(4)
Explanation of Responses:
1. The Class L ordinary shares will convert into Class A ordinary shares of the issuer at any time after the issuer's initial business combination only to the extent certain triggering events occur prior to the 5th anniversary of the issuer's initial business combination as described in the issuer's registration statement, subject to adjustment for share subdivisions, share dividends, rights issuances, reorganizations, recapitalizations and the like.
2. 25,000 represents the number of Class L ordinary shares beneficially owned by the Reporting Person as of the filing date of this Form 3. The Class L ordinary shares convert into a Class A ordinary shares at a ratiosuch that the number of Class A ordinary shares issuable upon conversion of the Class L ordinary shares will equal, in the aggregate, on an as-converted basis, 10%, 20% and 30% (based on the certain triggering eventsdescribed in the issuer's registration statement) of the sum of (i) the total number of all Class A ordinary shares (including private placement shares) issued and outstanding upon completion of the issuer's initial public offering (including any over-allotment shares if the underwriters exercise their over-allotment option), plus (ii) the total number of Class A ordinary shares issued or deemed issued or issuable conversion of the Class Lordinary shares plus
3. (Continued from Footnote 2) (iii) unless waived by the Reporting Person, the total number of Class A ordinary shares issued or deemed issued or issuable upon conversion or exercise of any equity-linked securities or rights issued or deemed issued, by the issuer in connection with or in relation to the consummation of the issuer's initial business combination, excluding (x) any Class A ordinary shares or equity-linked securities exercisable for or convertible into Class A ordinary shares issued, deemed issued, or to be issued, to any seller in the initial business combination, (y) any redemption of public shares in connection with the initial business combination or (z) any forward purchase shares. The Reporting Person only has an interest in Class L ordinary shares, which convert at the 1st triggering event described in the issuer's registration statement.
4. Owned through MELI Kaszek Pioneer Sponsor LLC.
Remarks:
/s/ Catherine Ambrose 09/28/2021
** 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.