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) 11/24/2015 | 3. Issuer Name and Ticker or Trading Symbol Andina Acquisition Corp. II [ ANDA ] | |||||||||||||
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) |
Ordinary Share(1) | 74,438 | D |
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 | ||||
Right to Receive Ordinary Share(1) | (2) | (3) | Ordinary Share | 2,857 | (2) | D | |
Redeemable Warrant(1) | (4) | (5) | Ordinary Share | 10,000 | (6) | D |
Explanation of Responses: |
1. Includes securities underlying 20,000 units of the Issuer, which units, prior to the effective date of the registration statement relating to the Issuer's initial public offering, Ms. Hernandez irrevocably committed to purchase. Each unit ("Unit") consists of one ordinary share, one right ("Right") to receive one-seventh of one ordinary share upon the consummation of the Issuer's initial business combination and one redeemable warrant ("Warrant") entitling the holder to purchase one-half of one ordinary share. The purchase of these units is being made on a private placement basis and will be consummated simultaneously with the consummation of the Issuer's initial public offering. |
2. Each Right entitles the holder to receive one-seventh (1/7) of one ordinary share upon consummation of the Issuer's initial business combination. |
3. If the Issuer fails to consummate an initial business combination within eighteen (18) months from the closing of the Issuer's initial public offering (or 21 months if certain criteria are met), the Issuer will be dissolved and the Rights will expire worthless. |
4. Each Warrant will become exercisable on the later of the completion of an initial business combination and November __, 2016. |
5. Each Warrant will expire five years after the completion of an initial business combination, or earlier upon redemption. |
6. Each Warrant entitles the holder thereof to purchase one-half of one ordinary share at a price of $11.50 per full share, exercisable in multiples of two. |
Remarks: |
/s/ Marjorie Hernandez | 11/24/2015 | |
** 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. |