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*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 09/21/2021
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3. Issuer Name and Ticker or Trading Symbol
Freshworks Inc.
[ FRSH ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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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)
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Form filed by One Reporting Person |
X |
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 |
Series A Preferred Stock |
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Class B Common Stock
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58,780 |
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I |
See footnotes
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Series D Preferred Stock |
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Class B Common Stock
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6,388,060 |
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I |
See footnotes
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Series E Preferred Stock |
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Class B Common Stock
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6,210,150 |
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I |
See footnotes
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Series G Preferred Stock |
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Class B Common Stock
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1,098,180 |
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I |
See footnotes
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Series H Preferred Stock |
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Class B Common Stock
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3,758,740 |
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I |
See footnotes
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Class B Common Stock |
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Class A Common Stock |
1,029,870 |
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I |
See footnotes
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Class B Common Stock |
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Class A Common Stock |
1,310,340 |
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I |
See footnotes
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Class B Common Stock |
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Class A Common Stock |
898,500 |
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I |
See footnotes
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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1. Name and Address of Reporting Person*
1600 AMPHITHEATRE PARKWAY |
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(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG 2014 LP |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG 2013 LP |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG II LP |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG LP |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG 2014 GP LLC |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG GP LLC |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG II GP LLC |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for ALPHABET HOLDINGS LLC |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for ALPHABET INC. |
09/21/2021 |
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/s/ Daniel Fox, as attorney-in-fact for CAPITALG 2013 GP LLC |
09/21/2021 |
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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
Know all by these presents, that each of the undersigned hereby constitutes and
appoints each of Sarah Solum, Pamela Marcogliese and Daniel Fox, acting
individually or jointly, with full power of substitution and resubstitution, as
the undersigned's true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in connection with the
undersigned's beneficial ownership of, or participation in a group with respect
to, securities beneficially owned, directly or indirectly, of Freshworks Inc., a
Delaware corporation (the "Company"), forms and documents related specially to
Section 13 and Section 16 of the Securities Exchange Act of 1934, as amended,
and the rules thereunder (the "Exchange Act");
(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 any such forms and
documents related specifically to Section 13 and Section 16 of the Exchange Act,
complete and execute any amendment or amendments thereto, and timely file such
form and documents with the U.S. Securities and Exchange Commission (the "SEC")
and any stock exchange or similar authority; and
(3) take any other lawful action or any type whatsoever in connection with the
foregoing which, in the opinion of any 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 any 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
any such attorney-in-fact's discretion.
The undersigned here by grants to each such attorney-in-fact with full power of
substitution or revocation, hereby ratifying and confirming all that each such
attorney-in-fact, or each such attorney-in-fact's substitute or substitutes,
shall lawfully do or cause to be done by virtue of this Power of Attorney and
the rights and powers herein granted. All lawful acts done by the
attorney-in-fact in this regard shall be deemed to have been done by the
undersigned. The undersigned acknowledges that the foregoing attorneys-in-fact,
in serving in such capacity at the request of the undersigned, are not assuming
any of the undersigned's responsibilities to comply with Section 13 or Section
16 of the Exchange Agreement.
This Power of Attorney shall continue in full force and effect until (1) revoked
by the undersigned in a signed writing delivered to the foregoing
attorneys-in-fact, (ii) revoked by such attorneys-in-fact in a signed writing
delivered to the undersigned or (iii) such time as the person or persons to whom
power of attorney has been hereby granted cease(s) to be an employee of
Freshfields Bruckhaus Deringer US LLP or any of its affiliates. This Power of
Attorney hereby revokes any previous Power of Attorney granted by the
undersigned with respect to the matters contained herein.
IN WITNESS WHEREOF, each of the undersigned has caused this Power of Attorney to
be executed as of this 20th day of September, 2021.
CAPITALG LP
By: CAPITALG GP LLC,
its General Partner
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
CAPITALG II LP
By: CAPITALG II GP LLC,
its General Partner
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
CAPITALG 2013 LP
By: CAPITALG 2013 GP LLC,
its General Partner
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
CAPITAL 2014 LP
By: CAPITALG 2014 GP LLC,
its General Partner
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
ALPHABET HOLDINGS LLC
By: /s/ Kathryn W. Hall
Name: Kathryn W. Hall
Title: Secretary
CAPITAL GP LLC
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
CAPITAL II GP LLC
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
CAPITALG 2013 GP LLC
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
CAPITALG 2014 GP LLC
By: /s/ Jeremiah Gordon
Name: Jeremiah Gordon
Title: General Counsel and Secretary
ALPHABET INC.
By: /s/ Kathryn W. Hall
Name: Kathryn W. Hall
Title: Assistant Secretary