-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, G9UmIOyBGOOJxb7CUO8B8JNKVdR44tg/Ne2PuN/1HVP/2QN6A+b3nfFS+CjdN/2e f33zDZECqIe1rFn2KWca2Q== 0000898430-96-004186.txt : 19960904 0000898430-96-004186.hdr.sgml : 19960904 ACCESSION NUMBER: 0000898430-96-004186 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960903 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SUNBASE ASIA INC CENTRAL INDEX KEY: 0000095626 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 941612110 STATE OF INCORPORATION: NV FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03132 FILM NUMBER: 96625112 BUSINESS ADDRESS: STREET 1: 19 F FIRST PACIFIC BANK CENTERE STREET 2: 51-57 GLOUCESTER ROAD CITY: WANCHAI HONG KONG STATE: K3 BUSINESS PHONE: 01185228651511 MAIL ADDRESS: STREET 1: P O BOX 2600 CITY: BAKERSFIELD STATE: CA ZIP: 93303 FORMER COMPANY: FORMER CONFORMED NAME: PAN AMERICAN INDUSTRIES INC DATE OF NAME CHANGE: 19941216 FORMER COMPANY: FORMER CONFORMED NAME: PAN AMERICAN ENERGY CORPORATION DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: SUPREME OIL & GAS CORP DATE OF NAME CHANGE: 19901029 COMPANY DATA: COMPANY CONFORMED NAME: RAFFINI GEORGE A CENTRAL INDEX KEY: 0001022068 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR STATE OF INCORPORATION: K3 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: C/O HPEM 10TH FLOOR CITIBANK TOWER STREET 2: CITIBANK PLAZA 3 GARDEN ROAD CENTRAL BUSINESS PHONE: 0116522845 MAIL ADDRESS: STREET 1: C/O HSBC PRIVATE EQUITY MANAGEMENT LTD STREET 2: CICIBANK PLAZA 3 GARDEN ROAD CITY: HONG KONG STATE: K3 3 1 STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES +--------+ | FORM 3 | U.S. 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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person Raffini George A. ---------------------------------------------------------------------------- (Last) (First) (Middle) c/o HPEM 10th Floor, Citibank Tower Citibank Plaza, 3 Garden Road, Central ---------------------------------------------------------------------------- (Street) Hong Kong ---------------------------------------------------------------------------- (City) (State) (Zip) 2. Date of Event Requiring Statement (Month/Day/Year) 8/21/96 -------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) 000-00-0000 -------------- 4. Issuer Name and Ticker or Trading Symbol Sunbase Asia, Inc. Asia ----------------------------------- 5. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] Officer [ ] 10% Owner [ ] Other (give title below) (specify below) ---------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) N/A ---------------------------- TABLE I--NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
- -------------------------------------------------------------------------------- 1. Title 2. Amount of 3. Ownership Form: 4. Nature of of Securities Bene- Direct (D) or Indirect Bene- Security ficially Owned Indirect (I) ficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5) - -------------------------------------------------------------------------------- N/A -0- N/A N/A - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- - --------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) FORM 3 (continued) TABLE II--DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities)
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conversion 5. Ownership 6. Nature of In- Security (Instr. 4) cisable and Underlying Derivative Security or Form of direct Bene- Expiration (Instr. 4) Exercise Derivative ficial Date Price Security: Ownership (Month/Day/ of Direct (D) (Instr. 5) Year) Derivative or In- ---------------------------------------------------- Security direct (I) Date Expira- Amount or (Instr. 5) Exer- tion Title Number of cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ N/A N/A N/A N/A -0- N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - -----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: No securities are beneficially owned. **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 provided is insufficient, See Instruction 6 for procedure. /s/ George A. Raffini September 3, 1996 ------------------------------- ----------------- **Signature of Reporting Person Date By: For: -----END PRIVACY-ENHANCED MESSAGE-----