SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
X
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
ROFF DAVID

(Last) (First) (Middle)
27 CHICORA AVENUE

(Street)
TORONTO A6 M5R 1T7

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
DEEP WELL OIL & GAS INC [ DWOG ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
See footnotes.
3. Date of Earliest Transaction (Month/Day/Year)
05/14/2020
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Expired) $0.38 09/19/2019 J 600,000(1) (2) 09/19/2019 Common Stock 600,000(1) $0.38 0(2) D
Explanation of Responses:
1. As of May 14, 2020, Mr. David Roff resigned as a director of the Issuer and is no longer subject to section 16 reporting requirements. As of May 14, 2020, the Reporting Person beneficially owns 848,155 shares (Non-Derivative Securities) of the Issuer's common stock of which shares are held directly. Mr. Roff has no Derivative Securities as reported in Table II above.
2. On September 19, 2014, the Issuer's Board granted Mr. David Roff, options to purchase 600,000 shares each of common stock at an exercise price of $0.38 per common share, with one-third vesting immediately, one-third vesting on September 19, 2015, and one-third vesting on September 19, 2016, each with a five-year life from the original grant date. These options have since expired unexercised. This transaction was previously reported on Form 4 and filed with the U.S. Securities and Exchange Commission on September 20, 2019. The purpose of this Form 4 is to disclose that Mr. David Roff is no longer subject to section 16 reporting requirements and that the transaction reported is not new or revised but is being reported again to gain access to the system to file Mr. Roff's final Form 4.
/s/ David Roff 05/20/2020
** 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 4 (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.