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 |
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 11/09/2021 |
3. Issuer Name and Ticker or Trading Symbol
Blockchain Coinvestors Acquisition Corp. I [ BCSA ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
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) |
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 B Ordinary Shares | (1) | (1) | Class A Ordinary Shares | 9,583,333(2) | (1) | I | By Blockchain Coinvestors Acquisition Sponsors I LLC(3) |
Explanation of Responses: |
1. The shares of Class B ordinary shares, par value $0.00009 per share, of the issuer will automatically convert into shares of Class A ordinary shares, par value $0.0001 per share, of the issuer upon the consummation of the issuer's initial business combination as described in the issuer's registration statement on Form S-1 (File No. 333-259091) (the "Registration Statement") in the section entitled "Description of Securities-Founders Shares." The shares of Class B ordinary shares have no expiration date. |
2. These shares represent Class B ordinary shares held by Blockchain Coinvestors Acquisition Sponsors I LLC (the "Sponsor") and include up to 1,250,000 shares of Class B ordinary shares that are subject to forfeiture depending on the extent to which the underwriters of the issuer's initial public offering exercise their over-allotment as described in the Registration Statement. |
3. As a manager of the Sponsor, the reporting person may be deemed to share beneficial ownership of the shares of Class B ordinary shares held by the Sponsor. The reporting person disclaims any beneficial ownership of any shares held by the Sponsor except to the extent of her ultimate pecuniary interest. |
/s/ Alison Davis | 11/09/2021 | |
** 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. |