SEC FORM
3
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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
SOCIAL CAPITAL SUVRETTA HLDNGS CORP III |
2850 W HORIZON RIDGE PARKWAY, STE 200 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/29/2021
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3. Issuer Name and Ticker or Trading Symbol
Social Capital Suvretta Holdings Corp. III
[ DNAC ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Chief Financial Officer |
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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)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
Remarks: |
No securities are beneficially owned. |
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/s/ James Ryans |
06/29/2021 |
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** 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. |
POWER OF ATTORNEY
For Executing Forms 3, 4 and 5
KNOW ALL BY THESE PRESENTS, that the undersigned hereby
constitutes and appoints each of Chamath Palihapitiya, Kishan
Mehta and Shoney Katz, or any of them, each acting
alone, his or her true and lawful attorney-in-fact to:
(1) execute for and on behalf of the
undersigned a Form 3, Form 4 or Form 5, or
any amendment thereto, relating to the
securities of Social Capital Suvretta
Holdings Corp. III, in accordance with Section
16(a) of the Securities Exchange Act of 1934
and the rules thereunder;
(2) do and perform any and all acts for and
on behalf of the undersigned which may be
necessary or desirable to complete and
execute such Form 3, Form 4 or Form 5, or
any amendment thereto, and the timely filing
of such form with the United States
Securities and Exchange Commission and any
other authority; and
(3) take any other action of any type
whatsoever in connection with the foregoing
which, in the opinion of such attorney-in-
fact, may be of benefit to, in the best
interest of, or legally required by, the
undersigned, it being understood that the
documents executed by such attorney-in-fact
on behalf of the undersigned pursuant to
this Power of Attorney shall be in such form
and shall contain such terms and conditions
as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full
power and authority to do and perform any and every act and
thing whatsoever requisite, necessary and proper to be done in
the exercise of any of the rights and powers herein granted, as
fully to all intents and purposes as such undersigned might or
could do if personally present, hereby ratifying and confirming
all that such attorney-in-fact shall lawfully do or cause to be
done by virtue of this Power of Attorney and the rights and
powers herein granted. The undersigned acknowledges that each of
the foregoing attorneys-in-fact, in serving in such capacity at
the request of the undersigned, is not assuming any of the
undersigned's responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934. This Power of Attorney shall
remain in full force and effect until the undersigned is no
longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued
by Social Capital Suvretta Holdings Corp. III unless earlier
revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney to be executed as of this 28th day of June, 2021.
By: /s/ James Ryans
Name: James Ryans