1182001 Form3 Doc

FORM 3

U.S. SECURITIES AND EXCHANGE COMMISSION

OMB APPROVAL

 

Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB Number: 3235-0104
Expires: April 30, 1997
Estimated average burden hours per response 0.5

 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(f) of the Investment Company Act of 1940

 

 

1. Name and Address of Reporting Person  

PeopleNet Corporation

2. Date of Event Requiring Statement

(Month/Day/Year)

03/21/2002
  1. Issuer Name and Ticker or Trading Symbol

PeopleNet International Corporation

(Last) (First) (Middle)

2001 Gateway Place, Suite 270 West

3. IRS or Social Security Number of Reporting Person (Voluntary)

 

5. Relationship of Reporting Person to Issuer

(Check all applicable)

____ Director    X   10% Owner

____ Officer (give title below) ____ Other (specify below)

6. If Amendment, Date of Original
(Month/Day/Year)

(Street)

San Jose, CA 95110

(City)     (State)      (Zip)

Table I - Non-Derivative Securities Beneficially Owned

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)

Common Stock, par value $0.0001 per share

9,620,000

D

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly (Over)

(Print or Type Responses) #9; SEC 1473 (8-92)

FORM 3 (continued) Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)

 

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 of Derivative Security: 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

 

 

 

          

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation of Responses:

** International misstatements or omissions of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). 		/s/ Benedict Van, President     April 8, 2002
**Signature of Reporting Person             Date

 

Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient.
See Instruction 6 for procedure.

 

Page 2

SEC 1473 (8-92)