SEC FORM
4
SEC Form 4
FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
C/O JACK CREEK INVESTMENT CORP., |
386 PARK AVENUE SOUTH, FL 20 |
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Jack Creek Investment Corp.
[ JCIC ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 01/24/2023
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4. 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 Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Class B Ordinary Shares, par value $0.0001 per share |
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01/24/2023 |
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G |
V |
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1,830,000 |
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Class A Ordinary Shares, par value $0.0001 per share |
1,830,000 |
$0.00
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2,413,189
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I |
See Footnotes
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Class B Ordinary Shares, par value $0.0001 per share |
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01/24/2023 |
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D |
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2,413,189 |
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Class A Ordinary Shares, par value $0.0001 per share |
2,413,189 |
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0 |
I |
See Footnotes
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1. Name and Address of Reporting Person*
C/O JACK CREEK INVESTMENT CORP., |
386 PARK AVENUE SOUTH, FL 20 |
(Street)
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1. Name and Address of Reporting Person*
C/O JACK CREEK INVESTMENT CORP., |
386 PARK AVENUE SOUTH, FL 20 |
(Street)
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1. Name and Address of Reporting Person*
C/O JACK CREEK INVESTMENT CORP., |
386 PARK AVENUE SOUTH, FL 20 |
(Street)
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1. Name and Address of Reporting Person*
C/O JACK CREEK INVESTMENT CORP., |
386 PARK AVENUE SOUTH, FL 20 |
(Street)
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1. Name and Address of Reporting Person*
C/O JACK CREEK INVESTMENT CORP., |
386 PARK AVENUE SOUTH, FL 20 |
(Street)
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Explanation of Responses: |
Remarks: |
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See Exhibit 99.1 |
01/24/2023 |
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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
4
(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. |
Exhibit 99.1
Joint Filer Information
Name of Joint Filer: JCIC Sponsor LLC
Address of Joint Filer: c/o
Jack Creek Investment Corp.
386 Park Avenue South, FL 20
New York, NY 10016
Relationship of Joint Filer to Issuer: 10% Owner, Director
Issuer Name and Ticker or Trading Symbol: Jack Creek Investment Corp.
[JCIC]
Date of Earliest Transaction Required
to be Reported:
(Month/Day/Year): January 24, 2023
Designated Filer: JCIC Sponsor LLC
Signature:
JCIC SPONSOR LLC
By its Manager, KSH CAPITAL LP
Acting by its General Partner
KSH CAPITAL GP LLC
By: /s/ Robert Savage
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Name: Robert Savage
Title: President
Dated: January 24, 2023
Joint Filer Information
(continued)
Name of Joint Filer: KSH Capital LP
Address of Joint Filer: c/o
Jack Creek Investment Corp.
386 Park Avenue South, FL 20
New York, NY 10016
Relationship of Joint Filer to Issuer: 10% Owner, Director
Issuer Name and Ticker or Trading Symbol: Jack Creek Investment Corp.
[JCIC]
Date of Earliest Transaction Required
to be Reported:
(Month/Day/Year): January 24, 2023
Designated Filer: JCIC Sponsor LLC
Signature:
KSH CAPITAL LP
Acting by its General Partner
KSH CAPITAL GP LLC
By: /s/ Robert Savage
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Name: Robert Savage
Title: President
Dated: January 24, 2023
Joint Filer Information
(continued)
Name of Joint Filer: Jeffrey E. Kelter
Address of Joint Filer: c/o
Jack Creek Investment Corp.
386 Park Avenue South, FL 20
New York, NY 10016
Relationship of Joint Filer to Issuer: Executive Chairman and Chairman
of the Board of Directors
Issuer Name and Ticker or Trading Symbol: Jack Creek Investment Corp.
[JCIC]
Date of Earliest Transaction Required
to be Reported:
(Month/Day/Year): January 24, 2023
Designated Filer: JCIC Sponsor LLC
Signature:
/s/ Jeffrey E. Kelter
-------------------------------
Jeffrey E. Kelter
Dated: January 24, 2023
Joint Filer Information
(continued)
Name of Joint Filer: Robert F. Savage
Address of Joint Filer: c/o
Jack Creek Investment Corp.
386 Park Avenue South, FL 20
New York, NY 10016
Relationship of Joint Filer to Issuer: Chief Executive Officer
Issuer Name and Ticker or Trading Symbol: Jack Creek Investment Corp.
[JCIC]
Date of Earliest Transaction Required
to be Reported:
(Month/Day/Year): January 24, 2023
Designated Filer: JCIC Sponsor LLC
Signature:
/s/ Robert Savage
-------------------------------
Robert F. Savage
Dated: January 24, 2023
Joint Filer Information
(continued)
Name of Joint Filer: Thomas Jermoluk
Address of Joint Filer: c/o
Jack Creek Investment Corp.
386 Park Avenue South, FL 20
New York, NY 10016
Relationship of Joint Filer to Issuer: President and Director
Issuer Name and Ticker or Trading Symbol: Jack Creek Investment Corp.
[JCIC]
Date of Earliest Transaction Required
to be Reported:
(Month/Day/Year): January 24, 2023
Designated Filer: JCIC Sponsor LLC
Signature:
/s/ Thomas Jermoluk
-------------------------------
Thomas Jermoluk
Dated: January 24, 2023