SEC Form 3
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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 03/12/2021 | 3. Issuer Name and Ticker or Trading Symbol Aeva Technologies, Inc. [ AEVA ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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) |
Class A Common Stock | 29,384,634 | I | See footnote(1) |
Class A Common Stock | 1,959,371 | I | See footnote(2) |
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 |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. These shares are owned directly by Lux Ventures IV, L.P. Lux Venture Partners IV, LLC is the general partner of Lux Ventures IV, L.P. and exercises voting and dispositive power over the shares noted herein held by Lux Ventures IV, L.P. Peter Hebert and Josh Wolfe are the individual managing members of Lux Venture Partners IV, LLC (the "Individual Lux Managers"). The Individual Lux Managers, as the sole managers of Lux Venture Partners IV, LLC, may be deemed to share voting and dispositive power for the shares noted herein held by Lux Ventures IV, L.P.. Each of Lux Venture Partners IV, LLC and the Individual Lux Managers separately disclaim beneficial ownership over the shares noted herein except to the extent of their pecuniary interest therein. |
2. These shares are owned directly by Lux Co-Invest Opportunities, L.P. Lux Co-Invest Partners, LLC is the general partner of Lux Co-Invest Opportunities, L.P. and exercises voting and dispositive power over the shares noted herein held by Lux Co-Invest Opportunities, L.P. The Individual Lux Managers are the individual managing members of Lux Venture Partners IV, LLC. The Individual Lux Managers, as the sole managers of Lux Co-Invest Partners, LLC, may be deemed to share voting and dispositive power for the shares noted herein held by Lux Co-Invest Opportunities, L.P. Each of Lux Co-Invest Partners, LLC and the Individual Lux Managers separately disclaim beneficial ownership over the shares noted herein except to the extent of their pecuniary interest. |
Remarks: |
Exhibit List Exhibit 24.1 - Power of Attorney Exhibit 24.2 - Power of Attorney |
/s/ Segolene Scarborough, Segolene Scarborough, Attorney-in-Fact for Peter Hebert | 03/19/2021 | |
/s/ Segolene Scarborough, Segolene Scarborough, Attorney-in-Fact for Josh Wolfe | 03/19/2021 | |
LUX VENTURE PARTNERS IV, LLC, /s/ Segolene Scarborough, Segolene Scarborough, Attorney-in-Fact for Peter Hebert, Managing Member | 03/19/2021 | |
LUX VENTURES IV, L.P., By: Lux Venture Partners IV, LLC, Its: General Partner, /s/ Segolene Scarborough, Segolene Scarborough, Attorney-in-Fact for Peter Hebert, Managing Member | 03/19/2021 | |
LUX CO-INVEST PARTNERS, LLC, /s/ Segolene Scarborough, Segolene Scarborough, Attorney-in-Fact for Peter Hebert, Managing Member | 03/19/2021 | |
LUX CO-INVEST OPPORTUNITIES, L.P., By: Lux Co-Invest Partners, LLC, Its: General Partner, /s/ Segolene Scarborough, Segolene Scarborough, Attorney-in-Fact for Peter Hebert, Managing Member | 03/19/2021 | |
** 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. |