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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Phantom Stock | (1) | 12/31/2004 | A | 539 | (2) | (2) | Common Shares | 539 | (1) | 539 | D | ||||
Phantom Stock | (3) | 01/03/2005 | A | 728 | (2) | (2) | Common Shares | 728 | (3) | 728 | D | ||||
Stock Option for Common Shares | $ 27.45 | 01/03/2005 | A | 8,000 | 01/03/2006(4) | 01/03/2015 | Common Shares | 8,000 | (5) | 8,000 | D | ||||
Phantom Stock | (6) | 01/03/2005 | A | 2,150 | (2) | (2) | Common Shares | 2,150 | (6) | 2,150 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FORRESTER W THOMAS C/O AXIS CAPITAL HOLDINGS LIMITED 106 PITTS BAY ROAD PEMBROKE, D0 HM 08 |
X |
Carol S. Rivers, Attorney in Fact | 01/04/2005 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Phantom stock represents common shares issued in lieu of directors' fees that have been deferred using the closing sale price on December 31, 2004 of $27.35 per share. |
(2) | Phantom stock is generally distributed when service as a director ceases. |
(3) | Phantom stock represents restricted shares issued in lieu of directors' fees that have been deferred using the closing sale price on January 3, 2005 of $27.45 per share. |
(4) | Option vests in three equal installments on the first, second and third anniversaries of the dte of grant. |
(5) | Option issued as directors' fees. |
(6) | Phantom stock represents common shares issued in lieu of directors' fees that have been deferred using the closing sale price on January 3, 2005 of $27.45 per share. |