Sec Form 4 Filing - JORDAN JEFFREY D @ Maplebear Inc. - 2023-09-21

FORM 4 Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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1. Name and Address of Reporting Person JORDAN JEFFREY D 2. Issuer Name and Ticker or Trading Symbol Maplebear Inc. [ CART] 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) X __ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below) (Last) (First) (Middle) C/O MAPLEBEAR INC., 50 BEALE STREET, SUITE 600 3. Date of Earliest Transaction (MM/DD/YY) 09/21/2023 (Street) SAN FRANCISCO, CA94105 4. If Amendment, Date Original Filed (MM/DD/YY) 6. Individual or Joint/Group Filing (Check Applicable Line) __ X __ Form filed by One Reporting Person _____ Form filed by More than One Reporting Person (City) (State) (Zip)

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1.Title of Security (Instr. 3) 2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4) Code V Amount (A) or (D) Price Common Stock 09/21/2023 C 295,465 A 295,465 I By a16z Seed-III, LLC ( 2 ) ( 3 ) Common Stock 09/21/2023 C 4,713,103 A 4,713,103 I By AH Parallel Fund IV, L.P., as nominee ( 3 ) ( 4 ) Common Stock 09/21/2023 C 6,495,150 A 6,495,150 I By Andreessen Horowitz Fund IV, L.P., as nominee ( 3 ) ( 5 ) Common Stock 09/21/2023 C 465,014 A 465,014 I By Andreessen Horowitz LSV Fund I, L.P., as nominee ( 3 ) ( 6 ) Non-Voting Common Stock 09/21/2023 J( 7 ) 20,783 D 0 D Common Stock 09/21/2023 J( 7 ) 20,783 A 20,783 D

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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 (MM/DD/YY) 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) Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares Series A Preferred Stock ( 1 ) 09/21/2023 C 295,465 ( 1 ) ( 1 ) Common Stock 295,465 $ 0 0 I By a16z Seed-III, LLC ( 2 ) ( 3 ) Series B Preferred Stock ( 1 ) 09/21/2023 C 3,676,060 ( 1 ) ( 1 ) Common Stock 3,766,368 $ 0 0 I By AH Parallel Fund IV, L.P., as nominee ( 3 ) ( 4 ) Series B Preferred Stock ( 1 ) 09/21/2023 C 5,066,000 ( 1 ) ( 1 ) Common Stock 5,190,455 $ 0 0 I By Andreessen Horowitz Fund IV, L.P., as nominee ( 3 ) ( 5 ) Series C Preferred Stock ( 1 ) 09/21/2023 C 379,105 ( 1 ) ( 1 ) Common Stock 379,105 $ 0 0 I By AH Parallel Fund IV, L.P., as nominee ( 3 ) ( 4 ) Series C Preferred Stock ( 1 ) 09/21/2023 C 522,440 ( 1 ) ( 1 ) Common Stock 522,440 $ 0 0 I By Andreessen Horowitz Fund IV, L.P., as nominee ( 3 ) ( 5 ) Series D Preferred Stock ( 1 ) 09/21/2023 C 567,630 ( 1 ) ( 1 ) Common Stock 567,630 $ 0 0 I By AH Parallel Fund IV, L.P., as nominee ( 3 ) ( 4 ) Series D Preferred Stock ( 1 ) 09/21/2023 C 782,255 ( 1 ) ( 1 ) Common Stock 782,255 $ 0 0 I By Andreessen Horowitz Fund IV, L.P., as nominee ( 3 ) ( 5 ) Series D Preferred Stock ( 1 ) 09/21/2023 C 65,014 ( 1 ) ( 1 ) Common Stock 65,014 $ 0 0 I By Andreessen Horowitz LSV Fund I, L.P., as nominee ( 3 ) ( 6 ) Series I Preferred Stock ( 1 ) 09/21/2023 C 400,000 ( 1 ) ( 1 ) Common Stock 400,000 $ 0 0 I By Andreessen Horowitz LSV Fund I, L.P., as nominee ( 3 ) ( 6 )

Reporting Owners Reporting Owner Name / Address Relationships Director 10% Owner Officer Other JORDAN JEFFREY D C/O MAPLEBEAR INC. 50 BEALE STREET, SUITE 600 SAN FRANCISCO, CA94105 X Signatures /s/ Bradley Libuit, Attorney-in-fact 09/25/2023 Signature of Reporting Person Date

Explanation of Responses:

( 1 )Immediately prior to the closing of the Issuer's initial public offering, each share of Series A Preferred Stock, Series C Preferred Stock, Series D Preferred Stock and Series I Preferred Stock converted into shares of Common Stock on a 1:1 basis and each share of Series B Preferred Stock converted into shares of Common Stock on a 1.024566722:1 basis. ( 2 )The shares are held of record by a16z Seed-III, LLC. ( 3 )Mr. Jordan is a member of the general partners of the AH Fund Entities (as defined herein), but he disclaims the existence of a "group" and disclaims beneficial ownership of the shares held by the AH Fund Entities and this report shall not be deemed an admission that he is the beneficial owner of such shares, except to the extent of his pecuniary interest, if any, in such shares by virtue of his interest in the AH Fund Entities, and/or the general partner entities thereof, as applicable. ( 4 )The shares are held of record by AH Parallel Fund IV, L.P., for itself and as nominee for AH Parallel Fund IV-A, L.P., AH Parallel Fund IV-B, L.P. and AH Parallel Fund IV-Q, L.P. (collectively, the "AH Parallel Fund IV Entities"). AH Equity Partners IV (Parallel), L.L.C. ("AH EP IV Parallel") is the general partner of the AH Parallel Fund IV Entities and has sole voting and dispositive power with regard to the shares held by the AH Parallel Fund IV Entities. The managing members of AH EP IV Parallel are Marc Andreessen and Benjamin Horowitz. Marc Andreessen and Benjamin Horowitz share voting and dispositive power with respect to the shares held by the AH Parallel Fund IV Entities. ( 5 )The shares are held of record by Andreessen Horowitz Fund IV, L.P., for itself and as nominee for Andreessen Horowitz Fund IV-A, L.P., Andreessen Horowitz Fund IV-B, L.P. and Andreessen Horowitz Fund IV-Q, L.P. (collectively, the "AH Fund IV Entities"). AH Equity Partners IV, L.L.C. ("AH EP IV") is the general partner of the AH Fund IV Entities and has sole voting and dispositive power with regard to the shares held by the AH Fund IV Entities. The managing members of AH EP IV are Marc Andreessen and Benjamin Horowitz. Marc Andreessen and Benjamin Horowitz share voting and dispositive power with respect to the shares held by the AH Fund IV Entities. ( 6 )The shares are held of record by Andreessen Horowitz LSV Fund I, L.P., for itself and as nominee for Andreessen Horowitz LSV Fund I-B, L.P. and Andreessen Horowitz LSV Fund I-Q, L.P. (collectively, the "AH LSV Fund I Entities", and together with the AH Fund IV Entities, the AH Parallel Fund IV Entities and a16z Seed-III, LLC, the "AH Fund Entities"). AH Equity Partners LSV I, L.L.C. ("AH EP LSV I") is the general partner of the AH LSV Fund I Entities and has sole voting and dispositive power with regard to the shares held by the AH LSV Fund I Entities. The managing members of AH EP LSV I are Marc Andreessen and Benjamin Horowitz. Marc Andreessen and Benjamin Horowitz share voting and dispositive power with respect to the shares held by the AH LSV Fund I Entities. ( 7 )Each share of Non-Voting Common Stock was automatically converted into one share of Common Stock in connection with the closing of theIssuer's initial public offering of Common Stock.

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