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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 | ||||||||
Warrant to Urchase Common Shares | $ 11.95 | 01/17/2005 | A | 34,032 | 11/20/2001 | 11/20/2011 | Common Shares | 34,032 | (3) | 1,121,388 | I | By Dragon Trust | |||
Warrant to Purchase Common Stock | $ 11.95 | 01/17/2005 | A | 11,344 | 11/20/2001 | 11/20/2011 | Common Shares | 11,344 | (3) | 373,793 | I | By JR Charman Children's Settlement |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
CHARMAN JOHN C/O AXIS CAPITAL HOLDINGS LIMITED 106 PITTS BAY ROAD PEMBROKE, D0 HM 08 |
X | CEO & President |
John R. Charman | 01/19/2006 | |
**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) | Grant of Restricted Stock. |
(2) | Includes 722,064 shares held directly, 1,804,908 shares held by Dragon Holdings Trust and 597,704 shares held by JR Charman Children's Settlement. Mr. Charman disclaims beneficial ownership of the shares held by the trusts. |
(3) | Pursuant to anti-dilution provisions in the warrant, the number of shares issuable upon exercise of the warrant automatically increases, and the exercise price automatically decreases, upon the payment of certain dividends by the issuer. |