0001209191-22-001213.txt : 20220104
0001209191-22-001213.hdr.sgml : 20220104
20220104210434
ACCESSION NUMBER: 0001209191-22-001213
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211230
FILED AS OF DATE: 20220104
DATE AS OF CHANGE: 20220104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: RAINA ROBIN
CENTRAL INDEX KEY: 0001244876
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-15946
FILM NUMBER: 22508591
MAIL ADDRESS:
STREET 1: 5 CONCOURSE PARKWAY S 3200
CITY: ATLANTA
STATE: GA
ZIP: 30328
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: EBIX INC
CENTRAL INDEX KEY: 0000814549
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373]
IRS NUMBER: 770021975
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1 EBIX WAY
CITY: JOHNS CREEK
STATE: GA
ZIP: 30097
BUSINESS PHONE: 678-281-2020
MAIL ADDRESS:
STREET 1: 1 EBIX WAY
CITY: JOHNS CREEK
STATE: GA
ZIP: 30097
FORMER COMPANY:
FORMER CONFORMED NAME: EBIX COM INC
DATE OF NAME CHANGE: 19991115
FORMER COMPANY:
FORMER CONFORMED NAME: DELPHI INFORMATION SYSTEMS INC /DE/
DATE OF NAME CHANGE: 19920703
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-12-30
0
0000814549
EBIX INC
EBIX
0001244876
RAINA ROBIN
1 EBIX WAY
JOHNS CREEK
GA
30097
1
1
1
0
Chairman & CEO
Common Stock
2021-12-30
4
F
0
40000
30.44
D
4092140
D
Common Stock
217064
I
The Robin Raina Foundation
The above shares of common stock are being forfeited exclusively to assist with the payment of the reporting person's tax obligations.
These shares of common stock were not sold as part of an open market trade but rather were part of an adjustment process by the Issuer with the shares of common stock being retired by the Issuer.
This number has been revised to include 200,000 shares of restricted stock that were granted in July 2020, but were inadvertently reported in Table II at the time of grant.
/s/ Robin Raina
2022-01-04