5 1 siroisform5011703.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person SIROIS, KEITH E. 16303 DOBSON COURT TAMPA, FL 33647 U.S.A. 2. Issuer Name and Ticker or Trading Symbol CHECKERS DRIVE-IN RESTAURANTS, INC. (CHKR) 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Day/Year JANUARY 17, 2003 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner ( X ) Officer (Give Title Below) ( ) Other (Specify Below) VICE PRESIDENT OF FRANCHISE OPERATIONS 7. Individual or Joint/Group Filing (Check Applicable) (X ) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CHECKERS DRIVE-IN RESTAURANTS, INC. CENTRAL INDEX KEY: 0000879554 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 581654960 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 SEC FILE NUMBER: 000-19649 BUSINESS/MAILING ADDRESS: STREET 1: 4300 WEST CYPRESS STREET, SUITE 600 CITY: TAMPA STATE: FL ZIP: 33607 BUSINESS PHONE: 8132837000 Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned Title of Non-Derivative Security Transaction Date Transaction Code Securities Acquired (A) or Disposed (D) Amount Beneficially Owned at End of Period Ownership Form: Direct or Indirect Nature of Indirect Beneficial Ownership Code V Amount A/D Price Common Stock* 03/22/02 P V 88.9120 A $10.79 D Common Stock* 06/27/02 P V 137.4453 A $10.69 D 2,498.7726 Table II Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) Title of Derivative Security Conversion or Exercise Price Transaction Date Transaction Code Number of Securities Acquired or Disposed Date Exercisable Expiration Date Title of Securities Amount of Underlying Securities Price of Security Number Beneficially Owned End of Month Ownership Direct or Indirect Nature of Indirect Beneficial Ownership Code V (A) (D) Common Stock (Right to Buy)** $10.80 04/08/02 A 30,000 04/08/03 04/08/12 C 30,000 30,000 D Explanation of Responses: * = Employee Stock Purchase Plan (ESPP) Shares ** = Vesting in 1/3 increments beginning 4/8/03 ______________________________________________ ______________ Signature of Reporting Person Date