Sec Form 4 Filing - Pasricha Mohit @ Roadzen Inc. - 2023-09-20

Insider filing report for Changes in Beneficial Ownership
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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
Pasricha Mohit
2. Issuer Name and Ticker or Trading Symbol
Roadzen Inc. [ RDZN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Financial Officer
(Last) (First) (Middle)
C/O ROADZEN INC., 111 ANZA BLVD. SUITE 109
3. Date of Earliest Transaction (MM/DD/YY)
09/20/2023
(Street)
BURLINGAME, CA94010
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
Ordinary Share ( 1 ) 09/20/2023 J 550,007 A 550,007 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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Pasricha Mohit
C/O ROADZEN I NC.
111 ANZA BLVD. SUITE 109
BURLINGAME, CA94010
Chief Financial Officer
Signatures
/s/ Jeremy Chang, Attorney-in-Fact 09/22/2023
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On September 20, 2023, the Issuer, formerly known as Vahanna Tech Edge Acquisition I Corp., acquired Roadzen, Inc. ("Roadzen") pursuant to an Agreement and Plan of Merger, as amended, by and among the Issuer, Roadzen and certain other parties thereto (the "Merger Agreement"). Pursuant to the Merger Agreement, (i) each outstanding share of Roadzen common stock, including common stock issued upon conversion of each outstanding share of Roadzen preferred stock, held by the Reporting Person was cancelled and converted into the right to receive 27.21 ordinary shares of the Issuer ("Issuer ordinary shares") and (ii) each restricted stock unit of Roadzen was assumed and converted into the right to receive 27.21 restricted stock units of the Issuer (each, an "Issuer RSU").
( 2 )(Continued from footnote 1) Each Issuer RSU represents the contingent right to receive one Issuer ordinary share. The securities reported herein represent Issuer ordinary shares underlying the Issuer RSUs issued under the Roadzen Inc. 2023 Omnibus Incentive Plan, as amended and/or restated from time to time (the "Plan"). The Issuer RSUs were issued to the Reporting Person pursuant to the Merger Agreement, which generally provided that, in connection with the closing of the merger, each unvested restricted stock unit in Roadzen would be assumed by the Issuer under the Plan as a "substitute award" and converted into the right to receive 27.21 Issuer RSUs. Each Issuer RSU fully vests on September 18, 2024, subject to the Reporting Person's continuous service with the Issuer through the vesting date.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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