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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 02/12/2013 |
3. Issuer Name and Ticker or Trading Symbol
AFFYMETRIX INC [ AFFX ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Common Stock(1) | 55,750(2) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Option to Purchase Common Stock | (3) | 12/15/2018 | Common Stock | 90,000 | $3.86 | D | |
Option to Purchase Common Stock | (4) | 02/14/2020 | Common Stock | 50,000 | $3.84 | D |
Explanation of Responses: |
1. This Form 3 does not include 50,000 performance-based restricted stock untits granted on February 14, 2013. These shares will be reported on subsequent Form 4s if and when the performance criteria are met. |
2. Includes (1) 25,000 restricted stock units granted on December 15, 2011 and 30,000 restricted stock units granted on February 14, 2013 (each restricted stock unit grant vests in equal annual installments over four years from the grant date) and (2) 750 shares purchased through the Employee Stock Purchase Plan of Affymetrix, Inc. on November 14, 2012. |
3. Stock option becomes exercisable in equal annual installments over four years from the grant date of December 15, 2011. |
4. Stock option becomes exercisable in equal annual installments over four years from the grant date of February 14, 2013. |
Remarks: |
/s/ Siang H. Chin, Attorney-in-Fact for David Weber | 02/19/2013 | |
** 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. |